TY - JOUR
T1 - Watchful waiting of the neck in early stage oral cancer is unfavourable for patients with occult nodal disease
AU - Dik, E. A.
AU - Willems, S. M.
AU - Ipenburg, N. A.
AU - Rosenberg, A. J W P
AU - van Cann, E. M.
AU - van Es, R.J.J.
PY - 2016/8
Y1 - 2016/8
N2 - For cT1/2N0 oral squamous cell carcinoma (OSCC), treatment of the neck is a matter of debate. Two treatment strategies were evaluated in this study: selective neck dissection (SND) and watchful waiting (WW). One hundred and twenty-three SND patients and 70 WW patients with cT1/T2N0M0 OSCC of the tongue, floor of mouth, or buccal mucosa were analysed retrospectively. Extracapsular spread (ECS), 3-year overall survival (OS), and disease-specific survival (DSS) were determined. Twenty-nine percent of SND patients and 13% of WW patients had occult nodal disease. WW-N+ patients showed thicker tumours as compared to WW-N0 patients (5 mm vs. 2 mm, P = 0.02). WW-N+ patients showed significantly more ECS as compared to SND-N+ patients (56% vs. 14%, P = 0.016) and had a significantly worse 3-year DSS than SND-N+ patients (56% vs. 82%, P = 0.02). For T1 OSCCs, a watchful waiting policy is acceptable if tumour thickness proves to be <4 mm. Otherwise, an additional treatment of the neck is advised, since WW-N+ patients show more ECS, with a worse DSS than SND-N+ patients.
AB - For cT1/2N0 oral squamous cell carcinoma (OSCC), treatment of the neck is a matter of debate. Two treatment strategies were evaluated in this study: selective neck dissection (SND) and watchful waiting (WW). One hundred and twenty-three SND patients and 70 WW patients with cT1/T2N0M0 OSCC of the tongue, floor of mouth, or buccal mucosa were analysed retrospectively. Extracapsular spread (ECS), 3-year overall survival (OS), and disease-specific survival (DSS) were determined. Twenty-nine percent of SND patients and 13% of WW patients had occult nodal disease. WW-N+ patients showed thicker tumours as compared to WW-N0 patients (5 mm vs. 2 mm, P = 0.02). WW-N+ patients showed significantly more ECS as compared to SND-N+ patients (56% vs. 14%, P = 0.016) and had a significantly worse 3-year DSS than SND-N+ patients (56% vs. 82%, P = 0.02). For T1 OSCCs, a watchful waiting policy is acceptable if tumour thickness proves to be <4 mm. Otherwise, an additional treatment of the neck is advised, since WW-N+ patients show more ECS, with a worse DSS than SND-N+ patients.
KW - Extracapsular spread
KW - Metastasis
KW - Oral squamous cell carcinoma
KW - Selective neck dissection
KW - Watchful waiting
UR - http://www.scopus.com/inward/record.url?scp=84962429226&partnerID=8YFLogxK
U2 - 10.1016/j.ijom.2016.03.007
DO - 10.1016/j.ijom.2016.03.007
M3 - Article
C2 - 27055978
AN - SCOPUS:84962429226
SN - 0901-5027
VL - 45
SP - 945
EP - 950
JO - International Journal of Oral and Maxillofacial Surgery
JF - International Journal of Oral and Maxillofacial Surgery
IS - 8
ER -