Is elective neck dissection justified in cT2N0M0 oral cavity cancer defined according to the AJCC eighth edition staging system?

Tsung Ming Chen, Shyuang Der Terng, Li Yu Lee, Shu Ru Lee, Shu Hang Ng, Chung Jan Kang, Jin Ching Lin, Chih Yen Chien, Chun Hung Hua, Cheng Ping Wang, Wen Cheng Chen, Yao Te Tsai, Chi Ying Tsai, Chien Yu Lin, Kang Hsing Fan, Hung Ming Wang, Chia Hsun Hsieh, Chih Hua Yeh, Chih Hung Lin, Chung Kan TsaoNai 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

1 Scopus citations


BACKGROUND: The current NCCN guidelines recommend considering elective neck dissection (END) for early-stage oral cavity squamous cell carcinoma (OCSCC) with a depth of invasion (DOI) exceeding 3 mm. However, this DOI threshold, determined by evaluating the occult lymph node metastatic rate, lacks robust supporting evidence regarding its impact on patient outcomes. In this nationwide study, we sought to explore the specific indications for END in patients diagnosed with OCSCC at stage cT2N0M0, as defined by the AJCC Eighth Edition staging criteria.

METHODS: We examined 4723 patients with cT2N0M0 OCSCC, of which 3744 underwent END and 979 were monitored through neck observation (NO).

RESULTS: Patients who underwent END had better 5-year outcomes compared to those in the NO group. The END group had higher rates of neck control (95% vs. 84%, p < 0.0001), disease-specific survival (DSS; 87% vs. 84%, p = 0.0259), and overall survival (OS; 79% vs. 73%, p = 0.0002). Multivariable analysis identified NO, DOI ≥5.0 mm, and moderate-to-poor tumor differentiation as independent risk factors for 5-year neck control, DSS, and OS. Based on these prognostic variables, three distinct outcome subgroups were identified within the NO group. These included a low-risk subgroup (DOI <5 mm plus well-differentiated tumor), an intermediate-risk subgroup (DOI ≥5.0 mm or moderately differentiated tumor), and a high-risk subgroup (poorly differentiated tumor or DOI ≥5.0 mm plus moderately differentiated tumor). Notably, the 5-year survival outcomes (neck control/DSS/OS) for the low-risk subgroup within the NO group (97%/95%/85%, n = 251) were not inferior to those of the END group (95%/87%/79%).

CONCLUSIONS: By implementing risk stratification within the NO group, we found that 26% (251/979) of low-risk patients achieved outcomes similar to those in the END group. Therefore, when making decisions regarding the implementation of END in patients with cT2N0M0 OCSCC, factors such as DOI and tumor differentiation should be taken into account.

Original languageEnglish
Article numbere6894
JournalCancer Medicine
Issue number1
Early online date03 01 2024
StatePublished - 01 2024

Bibliographical note

© 2024 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.


  • cT2N0M0
  • cancer registry
  • clinical outcomes
  • elective neck dissection
  • occult lymph node metastasis
  • oral cavity squamous cell carcinoma


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