Improved survival with elective neck dissection in thick early-stage oral squamous cell carcinoma.

Abstract

Management of the node-negative neck in T1 to T2 oral squamous cell carcinoma (SCC) remains controversial. The purpose of this study was to determine if elective neck dissection improves outcomes in thick primary tumors since this reflects current practice in most institutions and has not been specifically addressed in the literature. Retrospective analysis comparing elective neck dissection versus observation in 153 patients with T1 to T2 N0 oral SCC ≥4 mm thick. On multivariable analysis, elective neck dissection was a significant predictor of improved regional control (hazard ratio [HR], 0.1; p < .001), disease-specific (HR, 0.1; p < .001), and overall survival (HR, 0.3; p = .001). Regional failure accounted for 22% of disease-related deaths in the elective neck dissection group compared to 92% in the observation arm. Elective neck dissection is associated with a clinically significant survival advantage in thick T1 to T2 oral SCC by reducing the risk of regional failure, and we support its routine application in these patients.