Selective Neck Dissection and Survival in Pathologically Node-Positive Oral Squamous Cell Carcinoma

Abstract

The most important prognostic factor in oral squamous cell carcinoma (OSCC) is neck metastasis, which is treated by neck dissection. Although selective neck dissection (SND) is a useful tool for clinically node-negative OSCC, its efficacy for neck node-positive OSCC has not been established. Sixty-eight OSCC patients with pN1⁻3 disease who were treated with curative surgery using SND and/or modified-radical/radical neck dissection (MRND/RND) were retrospectively reviewed. The neck control rate was 94% for pN1⁻3 patients who underwent SND. The five-year overall survival (OS) and disease-specific survival (DSS) in pN1-3 OSCC patients were 62% and 71%, respectively. The multivariate analysis of clinical and pathological variables identified the number of positive nodes as an independent predictor of SND outcome (OS, hazard ratio (HR) = 4.98, 95% confidence interval (CI): 1.48⁻16.72, p < 0.01; DSS, HR = 6.44, 95% CI: 1.76⁻23.50, p < 0.01). The results of this retrospective study showed that only SND for neck node-positive OSCC was appropriate for those with up to 2 lymph nodes that had a largest diameter ≤3 cm without extranodal extension (ENE) of the neck and adjuvant radiotherapy. However, the availability of postoperative therapeutic options for high-risk OSCC, including ENE and/or multiple positive lymph nodes, needs to be further investigated.

Keywords: metastatic nodal parameters; oral squamous cell carcinoma; pathologically positive nodes; selective neck dissection; survival.

Figure 1

The five-year Kaplan–Meier survival estimates by extent of neck dissection for overall survival (A, C and E) and disease-specific survival (B, D and F); A and B show the survival curves of cN0, cN1 versus cN2. C and D show the survival curves of pN1 versus pN2 versus pN3. According to the number of positive lymph nodes (divided into ≤2: E, F and >2: E, F).