Count on it.

Top Line: Elective neck dissection improves overall survival (80% v 68% at 3 years) in patients with cT1-2N0 oral cavity squamous cell carcinoma (OCSCC).

The Study: That’s because ~30% of patients have occult nodal disease and ~45% fail in the neck without elective neck dissection. This study sought to determine if the extent of neck dissection was associated with recurrence risk in a multicenter cohort of 523 patients with cT1-2N0 OCSCC. Lymph node yield and lymph node ratio (positive nodes to total nodes dissected) were calculated for each case. Overall, 21% of patients had occult positive nodes, and 29% of patients received adjuvant radiation. The median lymph node yield was 22. Lymph node yield showed an almost linear relationship with the frequency of detecting nodal metastasis and the number of positive nodes. Among patients with pN0 disease, 5 year locoregional control was significantly higher when ≥18 LN were dissected (81%) compared to <18 (70%) as was the rate of disease free survival (74% v 58%). Lymph node yield wasn’t associated with control for ypN+ disease. Interestingly, LRC and DFS for those with pN0 disease and <18 LN dissected were similar to those with pN1 disease. In other words, it is much more likely that those with <18 lymph nodes dissected actually harbored occult metastatic disease compared to those with a higher yield. It is unclear how to interpret these findings in the setting of trials showing the non-inferiority of sentinel lymph node biopsy for OCSCC.

TBL: Fewer dissected lymph nodes in the pN0 neck is associated with a higher risk of locoregional recurrence and could be a risk factor to consider when weighing adjuvant radiation for OCSCC. | Farrokhian, JAMA Otolaryngology Head Neck Surg 2022