Occult metastasis is no burden factor in oral squamous cell carcinoma patients when adhering to a standardized approach in neck dissection

Abstract

Objectives Management of the neck in patients with oral squamous cell carcinoma (OSCC) is pivotal to oncologic control and survival. However, there is controversy regarding necessity of neck dissection (ND) in patients with clinically node-negative neck. We aimed to assess risk factors for occult metastasis and to explore whether the presence of occult lymph node metastases (LNMs) has an impact on recurrence and survival. Material and methods A retrospective cohort study was performed including patients with primary OSCC who underwent radical tumor resection and ND in a high-volume center adhering to the prevailing German guideline. The ND was performed according to a standardized approach. Results Four hundred twenty-one patients with primary surgically treated OSCC were included. The incidence of occult metastasis was 14.49%. A pathological T stage > 1 (multivariate analysis, odds ratio (OR) 3.958, p = 0.042) and the presence of extranodal extension in LNMs (multivariate analysis, OR 0.287, p = 0.020) were identified as independent risk factors for occult metastasis. When comparing patients with and without occult metastasis, there were no significant differences in terms of progression-free survival (log-rank, p = 0.297) and overall survival (log-rank, p = 0.320). There were no cases of ipsilateral neck recurrence. One patient developed contralateral neck metastasis; however, he initially presented with a unilateral pT1 pN0 tumor. Conclusions Overall, our findings suggest that conducting a standardized approach in ND should be applied in terms of management of the neck in order to maintain survival rates and to prevent neck recurrence in OSCC patients. Clinical relevance. None of the risk factors for occult metastasis can be reliably assessed preoperatively. Although elective ND does not guarantee the complete prevention of neck recurrence, it increases the likelihood of either timely removal of micrometastases or strengthens the justification for adjuvant therapy. Consequently, this approach leads to improvements in clinical outcomes.

Predictors of Occult Metastasis and Prognostic Factors in Patients with cN0 Oral Cancer Who Underwent Elective Neck Dissection

“…The incidence of OM is reported to be 7-33.75% in cN0 OSCC [7][8][9][10][11][12]. This study observed OM in 9 (10.5%) of the 86 patients, consistent with previous reports.…”

“…The indication of END for a cN0 neck is controversial. Some investigators reported that END could prevent regional recurrence [9,12], while others considered END an aggressive treatment because of shoulder dysfunction and aesthetic side effects [29,30], and the observation policy is considered reasonable for appropriately selected patients who can undergo very close follow-ups [4,5]. In this study, we applied END to patients with reconstructive surgery, a tumor depth ≥ 4 mm in tongue cancer, and more than a segmental resection of the mandible performed when a cervical approach was required for primary resection.…”

“…The incidences of metastases following neck dissection (ND) in cN0 oral squamous cell carcinoma (OSCC) are reportedly 7-33.75%. However, the early resection of LN metastases may increase the chances of survival [7][8][9][10][11][12]. Although failure after SOHND occurs in 2.1% of the cases, SOHND is appropriate for treating cN0 OSCC [8].…”

“…Although failure after SOHND occurs in 2.1% of the cases, SOHND is appropriate for treating cN0 OSCC [8]. A systematic review and meta-analysis concluded that ENDs significantly reduce the rate of regional nodal recurrence and the death related to it in patients with OSCC [9,12]. In contrast, neck recurrence and patient survival after SOHND appear not to be related to the pathological node (pN) stage [6]; pN negativity (pN0) does not guarantee future recurrence after END in patients who are cN0 [3].…”