Adequacy of Disease Control by Supraomohyoid Neck Dissection in cT1/T2 Tongue Cancer

Abstract

Background: Patients affected by oral tongue squamous cell carcinoma (OTSCC) underwent a supraomohyoid neck dissection (SOHND) or modified radical neck dissection (mRND) according to the clinical nodal status (cN0 vs. cN+). We investigate whether the type of neck dissection affects survival with the presence of extranodal extension (ENE) and multiple nodal metastases (MNM).

Methods: We conducted a retrospective study enrolling surgically treated patients affected by cT1/T2 OTSCC and MNM or ENE. The outcomes assessed were: overall survival (OS), disease-free survival (DFS), and neck-control- and metastases-free survival (NC-MFS). Survival curves were plotted by the Kaplan-Meier method and the log-rank test. Furthermore, we conducted a multivariable analysis with the Cox regression model.

Results: We included a total of 565 patients (36% cT1, 64% cT2). Of these, 501 patients underwent a SOHND, and 64 underwent an mRND. A total of 184 patients presented rpN+, with 28.7% of these in the SOHND group and 62.5% of these in the mRND group. We identified no significant differences in OS, DFS, and NC-MFS in the whole pN+ cohort, in the MNM, and the ENE subgroups. In the multivariable analysis, the type of ND did not affect OS and DFS.

Conclusions: Treating cT1-2 N0/+ tongue cancer with SOHND is oncologically safe. ENE and MNM patients do not benefit from an mRND.

Keywords: head and neck cancer; neck dissection; oral cancer; skip metastases; supraomohyoid neck dissection; tongue cancers.

Figure 1

(A) Disease-free survival differences in pN+ patients by types of neck dissection (n = 184, p = 0.51); (B) overall survival differences in pN+ patients by types of neck dissection (p = 0.12). Dotted line indicated the survival time that half of the patients had no events.

Figure 2

(A) Disease-free survival differences in multiple nodal disease by types of neck dissection (n =100, p = 0.52); (B) overall survival differences in multiple nodal disease by types of neck dissection (p = 0.11). Neck-control-distant metastases-free survival in multiple nodal disease by types of neck dissection. Dotted line indicated the survival time that half of the patients had no events.

Figure 3

(A) Disease-free survival differences in extranodal extension+ (ENE+) by types of neck dissection (n = 94, p = 0.44); (B) overall survival differences in extranodal extension+ (ENE+) by types of neck dissection (p = 0.59). Neck-control-distant metastases-free survival in extranodal extension+ (ENE+) by types of neck dissection. Dotted line indicated the survival time that half of the patients had no events.