Indications for elective neck dissection in cT1N0M0 oral cavity cancer according to the AJCC eight edition: A nationwide study

Chih Yen Chien, Cheng Ping Wang, Li Yu Lee, Shu Ru Lee, Shu Hang Ng, Chung Jan Kang, Jin Ching Lin, Shyuang Der Terng, Chun Hung Hua, Tsung Ming Chen, Wen Cheng Chen, Yao Te Tsai, Chi Ying Tsai, Ying Hsia Chu, Chien Yu Lin, Kang Hsing Fan, Hung Ming Wang, Chia Hsun Hsieh, Chih Hua Yeh, Chih Hung LinChung Kan Tsao, Nai Ming Cheng, Tuan Jen Fang, Shiang Fu Huang, Li Ang Lee, Ku Hao Fang, Yu Chien Wang, Wan Ni Lin, Li Jen Hsin, Tzu Chen Yen, Yu Wen Wen*, Chun Ta Liao

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

10 Scopus citations


Objectives: According to the NCCN guidelines, there is weak evidence to support the use of elective neck dissection (END) in early-stage oral cavity squamous cell carcinoma (OCSCC). We sought to examine the indications for END in patients with cT1N0M0 OCSCC defined according to the AJCC Staging Manual, Eight Edition. Methods: Of the 3886 patients diagnosed with cT1N0M0 included in the study, 2065 underwent END and 1821 neck observation. Results: The 5-year outcomes for patients who received END versus neck observation before and after propensity score matching (n = 1406 each) were as follows: neck control, 96 %/90 % (before matching), p < 0.0001; 96 %/90 % (after matching), p < 0.0001; disease-specific survival (DSS), 93 %/92 % (before matching), p = 0.0227; 93 %/92 % (after matching), p = 0.1436. Multivariable analyses revealed that neck observation, depth of invasion (DOI) > 2.5 mm, and poor differentiation were independent risk factors for 5-year outcomes. Upon the application of a scoring system ranging from 0 (no risk factor) to 3 (presence of the three risk factors), the following 5-year rates were observed: neck control, 98 %/95 %/84 %/85 %; DSS, 96 %/93 %/88 %/85 %; and overall survival, 90 %/86 %/79 %/59 %, respectively (all p < 0.0001). The survival outcomes of patients with scores of 0 and 1 were similar. The occult metastasis rates in the entire study cohort, DOI > 2.5 mm, and poor differentiation were 6.8 %/9.2 %/17.1 %, respectively. Conclusion: Because all patients who received neck observation had a score of 1 or higher, END should be performed when a DOI > 2.5 mm or poorly differentiated tumors are present. Under these circumstances, 48.6 % (1888/3886) of cT1N0M0 patients may avoid END without compromising oncological outcomes.

Original languageEnglish
Article number106366
Pages (from-to)106366
JournalOral Oncology
StatePublished - 05 2023

Bibliographical note

Copyright © 2023. Published by Elsevier Ltd.


  • Cancer registry
  • Clinical outcomes
  • Elective neck dissection
  • Occult nodal metastasis
  • Oral cavity squamous cell carcinoma
  • cT1N0M0
  • Humans
  • Lymphatic Metastasis
  • Squamous Cell Carcinoma of Head and Neck/pathology
  • Carcinoma, Squamous Cell/pathology
  • Mouth Neoplasms/pathology
  • Retrospective Studies
  • Neoplasm Staging
  • Head and Neck Neoplasms/pathology
  • Neck Dissection


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