Selective neck dissection is effective in N1/N2 nodal stage oral cavity squamous cell carcinoma
Publication Type:Journal Article
Source:Journal of Oral and Maxillofacial Surgery, Volume 71, Number 3, p.636-643 (2013)
Keywords:Adjuvant, adjuvant therapy, adult, aged, article, cancer classification, cancer control, cancer staging, Carcinoma, cheek mucosa, chemoradiotherapy, Chi-Square Distribution, clinical article, disease free survival, Disease-Free Survival, female, histopathology, human, Humans, Kaplan-Meier Estimate, Local, lymph node metastasis, lymph vessel metastasis, male, middle aged, mouth cavity, Mouth Neoplasms, mouth squamous cell carcinoma, neck dissection, Neoplasm Grading, Neoplasm Recurrence, Neoplasm Staging, overall survival, patient safety, Radiotherapy, recurrence free survival, recurrence risk, Retrospective Studies, retrospective study, Safety, sentinel lymph node biopsy, Squamous Cell, tongue, treatment outcome, tumor recurrence
Purpose: Although the efficacy of selective neck dissection (SND) in the management of a node-negative neck is established, its utility in the management of node-positive disease remains controversial. The objective of this study was to evaluate the oncologic safety of SND in the management of N1/N2 oral cavity squamous cell carcinoma. Materials and Methods: From a prospectively collected electronic database of patients with oral cavity cancer, a retrospective analysis was conducted of patients with nonrecurrent, clinical, and/or pathologic N1/N2 oral cavity squamous cell carcinoma who underwent SND of levels I to III/IV. The patients were stratified into 2 groups: clinical N0 but pathologic N1/N2 (cN0-pN1/N2) and clinical N1/N2 (cN1/N2). The primary outcome variable of the study was the ipsilateral regional recurrence rate. Categorical data were analyzed by the 2-sided Fisher exact test, and 3-year Kaplan-Meier ipsilateral regional control rate, regional recurrence-free survival, disease-free survival, and overall survival were estimated. Results: Forty-nine patients constituted the study sample, with 37 patients in the cN1/N2 group and 12 patients in the cN0-pN1/N2 group. During the follow-up period of 3 years, 2 patients (∼4%) developed ipsilateral neck recurrence, and these patients were in the cN1/N2 group. The 3-year Kaplan-Meier ipsilateral regional control rate was 95%. Conclusions: SND may produce a satisfactory ipsilateral regional control rate in patients with early-stage node-positive oral squamous cell carcinoma. A prospective, randomized clinical trial comparing SND with modified radical neck dissection may be required for a categorical conclusion of these findings. © 2013 American Association of Oral and Maxillofacial Surgeons.
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