title: Watchful waiting of the neck in early stage oral cancer is unfavourable for patients with occult nodal disease.
abstract: For cT1/2N0 oral squamous cell carcinoma (OSCC), treatment of the neck is a matter of debate. Two treatment strategies were evaluated in this study: selective neck dissection (SND) and watchful waiting (WW). One hundred and twenty-three SND patients and 70 WW patients with cT1/T2N0M0 OSCC of the tongue, floor of mouth, or buccal mucosa were analysed retrospectively. Extracapsular spread (ECS), 3-year overall survival (OS), and disease-specific survival (DSS) were determined. Twenty-nine percent of SND patients and 13% of WW patients had occult nodal disease. WW-N+ patients showed thicker tumours as compared to WW-N0 patients (5mm vs. 2mm, P=0.02). WW-N+ patients showed significantly more ECS as compared to SND-N+ patients (56% vs. 14%, P=0.016) and had a significantly worse 3-year DSS than SND-N+ patients (56% vs. 82%, P=0.02). For T1 OSCCs, a watchful waiting policy is acceptable if tumour thickness proves to be <4mm. Otherwise, an additional treatment of the neck is advised, since WW-N+ patients show more ECS, with a worse DSS than SND-N+ patients.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, Netherlands. Electronic address: eric.dik@mumc.nl.
authors.forename: E A
authors.initials: EA
authors.lastname: Dik
authors.affiliation: Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: S M
authors.initials: SM
authors.lastname: Willems
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: N A
authors.initials: NA
authors.lastname: Ipenburg
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: A J W P
authors.initials: AJ
authors.lastname: Rosenberg
authors.affiliation: Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: E M
authors.initials: EM
authors.lastname: Van Cann
authors.affiliation: Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: R J J
authors.initials: RJ
authors.lastname: van Es
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology* / Q000601:surgery*; D037981:Neck Dissection; D009367:Neoplasm Staging; D012189:Retrospective Studies; D057832:Watchful Waiting
keywords: extracapsular spread; metastasis; oral squamous cell carcinoma; selective neck dissection; watchful waiting