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. 2024 Jan 6;24(1):32.
doi: 10.1186/s12903-023-03632-5.

Do patients with cN0 oral squamous cell carcinoma benefit from elective neck dissection? A large-scale population-based study

Qiuyu Wu #  1   2 , Yuanhang Xia #  1   2 , Ling Qiu #  3 , Shuqiong Wen  1   2 , Qunxing Li  3 , Xiang Gao  4 , Wenrong Jiang  1   2 , Tao Wang  4 , Ping Ji  5   6 , Zhanpeng Ou  7   8
Affiliations

Do patients with cN0 oral squamous cell carcinoma benefit from elective neck dissection? A large-scale population-based study

Qiuyu Wu et al. BMC Oral Health. .

Abstract

Background: The neck management of clinical-nodal negative (cN0) oral squamous cell carcinoma (OSCC) remains controversial. Elective neck dissection (END) and observation are the main strategies, but it is still not clear who could benefit the most from END. The purpose of this study was to clarify the potential clinical factors that affect the therapeutic value of END and to explore the actual characteristics associated with benefit from END.

Methods: Patients with cN0 OSCC were identified in the SEER database from 2000 to 2019. 5-year Overall survival (OS) and disease-specific survival (DSS) were analyzed using the Kaplan‒Meier method, and the hazard ratios (HRs) for survival were estimated using the Cox regression model. Multiple subgroup analyses of DSS and OS among different factors, comparing END and No END, were performed.

Results: A total of 17,019 patients with cN0 OSCC were included. The basic survival analysis and Cox regression model showed that END increased the probability of 5-year DSS and OS and was an independent prognostic factor. However, among patients who underwent only primary tumor surgery, no significant differences were found between the END and No END groups in 5-year DSS (P = 0. 585) and OS (P = 0.465). Further subgroup analysis showed that primary sites and T stage, but not other factors, might influence the benefit of END. Significant differences were found for T1 (P < 0.001 for OS) and T2 (P = 0.001 for DSS and < 0.001 for OS) tongue squamous cell carcinoma (TSCC) but not for other primary tumor sites.

Conclusion: This large-scale retrospective population-based cohort study suggests that not all patients with cN0 OSCC could benefit from END. Patients with cN0 TSCC are recommended to undergo END, especially with early-stage tumors.

Keywords: Clinical-nodal negative; Disease-specific survival; Elective neck dissection; Multiple subgroup analyses; Oral squamous cell carcinoma; Overall survival; SEER database.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
DSS (A) and OS (B) curves of patients with cN0 OSCC with or without END. Abbreviations: DSS Disease-specific survival, END Elective neck dissection, OS Overall survival, OSCC Oral squamous cell carcinoma
Fig. 2
Fig. 2
DSS (A) and OS (B) curves of patients with cN0 OSCC according to different treatment categories with END subgroup analysis. Abbreviations: DSS Disease-specific survival, END Elective neck dissection, OS Overall survival, OSCC Oral squamous cell carcinoma
Fig. 3
Fig. 3
Forest plots summarizing hazard ratios for DSS (A) and OS (B) of patients who only underwent primary site surgery without radiation and chemotherapy. Abbreviations: AI American Indian/Alaska Native, API Asian or Pacific Islander, B black, CI Confidence interval, DSS Disease-specific survival, END Elective neck dissection, HR Hazard ratio, MX Unknown M stage, OS Overall survival
Fig. 4
Fig. 4
Subgroup survival analysis of END in cN0 OSCC patients who only underwent primary site surgery without radiation and chemotherapy according to the primary site (A, B) or T stage (C, D). Abbreviations: DSS Disease-specific survival, END Elective neck dissection, OS Overall survival, OSCC Oral squamous cell carcinoma
Fig. 5
Fig. 5
DSS (A) and OS (B) curves represent the cross-subgroup survival analysis of END in cN0 OSCC patients who only underwent primary site surgery without radiation and chemotherapy according to the primary sites and T stages. Abbreviations: DSS Disease-specific survival, END Elective neck dissection, OS Overall survival, OSCC Oral squamous cell carcinoma
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