Neck dissection improves the prognosis of patients with early-stage oral squamous cell carcinoma

Abstract

For early-stage oral squamous cell carcinoma (OSCC), the primary treatment modality generally entails surgical resection. However, the role of neck dissection in early-stage OSCC remains controversial. The aim of this study was to evaluate the effect of neck dissection on the prognosis of patients with early-stage OSCC. We identified patients with early-stage OSCC from the Surveillance, Epidemiology, and End Results database spanning from 2004 to 2021. We collected demographic and clinical data, including age, sex, tumor site, marital status, race, residence, income, grade, records of radiotherapy and chemotherapy, neck management modality, survival time, disease-specific survival (DSS), and overall survival (OS). A retrospective cohort study design was employed to differentiate between the neck observation and neck dissection group. Kaplan-Meier survival analysis and Cox regression were utilized to evaluate the association between neck dissection and survival outcome. The study included 12,606 patients, of whom 5135 died (available for OS analysis), and 2477 died from OSCC (available for DSS analysis). Kaplan-Meier survival analysis revealed statistically differences between the observation and neck dissection group in OS (p < 0.0001) and DSS (p = 0.00067). Multivariate analysis confirmed that neck dissection was associated with improved survival, after adjusting for multiple factors such as, age, sex, tumor site, marital status, race, residence, income, grade, records of radiotherapy and chemotherapy, neck dissection was associated with a decreased risk of both DSS (hazard ratio [HR] = 0.73, 95% confidence interval [CI] = 0.66-0.8; p < 0.001) and OS (HR = 0.76, 95% CI = 0.71-0.81; p < 0.001). Patients with early-stage OSCC may derive significant clinical benefit from neck dissection; therefore, neck dissection is recommended for such patients.

Keywords: Disease-specific survival; Early-stage; Oral squamous cell carcinoma (OSCC); Overall survival; neck dissection; neck observation.

Fig. 1

Flow chart of the study.

Fig. 2

Forest plot illustrating the association between neck dissection and survival outcome across various subgroups: (A) DSS: disease-specific survival; (B) OS: overall survival.

Fig. 3

Survival curve of patients with or without neck dissection. Kaplan–Meier curves of DSS (A) and OS (B) of patients with or without neck dissection; DSS (C) and OS (D) of patients among the observation, SND, and the SLNB group.