Patients with unilateral squamous cell carcinoma of the tongue and ipsilateral lymph node metastasis do not profit from bilateral neck dissection
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The purpose of this study was to evaluate the necessity of elective bilateral neck dissection for treating strict unilateral squamous cell carcinoma (SCC) of the tongue.
A cohort of 169 patients with unilateral non-midline crossing SCCs of the tongue treated by local resection and neck dissection was investigated. Study endpoints were nodal relapse and overall survival. The mean follow-up was 7.4 years.
A total of 146 (88.1%) patients were treated by neck dissection. Lymph node metastases were diagnosed in 50 (34.2%) patients. Only two (1.1%) had contralateral lymph node metastases. Risk factors for developing a primary lymph node metastasis were size of tumor (T2/T3, p = 0.03; OR = 2.2), lymphangiosis (p = 0.003; OR = 4.7), and higher-grade differentiation (p = 0.051; OR = 2.43). Metachronous lymph node metastases were detected in 23 (13.6%) patients (19 ipsilateral, one contralateral and three bilateral). The main risk factor for developing a metachronous lymph node metastasis was the presence of a primary lymph node metastasis (p = 0.004; HR = 4.65). Patients with initial neck dissection came up with lower 5-year recurrence rates (13.6%) compared to patients without neck dissection (27.3%; p = 0.014). Bilateral neck dissection showed no advantage regarding nodal relapse free and overall survival (p = 0.606) compared to unilateral neck dissection irrespective of initial N or T stage.
Patients with unilateral SCC of the tongue benefit from an ipsilateral neck dissection regarding nodal relapse. The value of elective bilateral neck dissection as standard treatment seems questionable even if positive lymph nodes were diagnosed ipsilateral at primary therapy.
KeywordsOral tongue squamous cell carcinoma Elective neck dissection Bilateral Ipsilateral Oral cancer Head and neck cancer
Compliance with ethical standards
This study was not funded. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study has been approved by the appropriate Ethical Committee (17-TEMP186882-104).
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.D’Cruz AK, Vaish R, Kapre N, Dandekar M, Gupta S, Hawaldar R, Agarwal JP, Pantvaidya G, Chaukar D, Deshmukh A, Kane S, Arya S, Ghosh-Laskar S, Chaturvedi P, Pai P, Nair S, Nair D, Badwe R, Head, Neck Disease Management G (2015) Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med 373(6):521–529. https://doi.org/10.1056/NEJMoa1506007 CrossRefPubMedGoogle Scholar
- 2.Ren ZH, Xu JL, Li B, Fan TF, Ji T, Zhang CP (2015) Elective versus therapeutic neck dissection in node-negative oral cancer: evidence from five randomized controlled trials. Oral Oncol 51(11):976–981. https://doi.org/10.1016/j.oraloncology.2015.08.009 CrossRefPubMedGoogle Scholar
- 4.Yuen AP, Ho CM, Chow TL, Tang LC, Cheung WY, Ng RW, Wei WI, Kong CK, Book KS, Yuen WC, Lam AK, Yuen NW, Trendell-Smith NJ, Chan YW, Wong BY, Li GK, Ho AC, Ho WK, Wong SY, Yao TJ (2009) Prospective randomized study of selective neck dissection versus observation for N0 neck of early tongue carcinoma. Head Neck 31(6):765–772. https://doi.org/10.1002/hed.21033 CrossRefPubMedGoogle Scholar
- 5.Feng Z, Li JN, Li CZ, Guo CB (2014) Elective neck dissection versus observation in the management of early tongue carcinoma with clinically node-negative neck: a retrospective study of 229 cases. J Craniomaxillofac Surg 42(6):806–810. https://doi.org/10.1016/j.jcms.2013.11.016 CrossRefPubMedGoogle Scholar
- 6.Nobis CP, Otto S, Grigorieva T, Alnaqbi M, Troeltzsch M, Schope J, Wagenpfeil S, Ehrenfeld M, Wolff KD, Kesting MR (2017) Elective neck dissection in unilateral carcinomas of the tongue: unilateral versus bilateral approach. J Craniomaxillofac Surg 45(4):579–584. https://doi.org/10.1016/j.jcms.2017.01.008 CrossRefPubMedGoogle Scholar
- 10.Keski-Santti H, Atula T, Tornwall J, Koivunen P, Makitie A (2006) Elective neck treatment versus observation in patients with T1/T2 N0 squamous cell carcinoma of oral tongue. Oral Oncol 42(1):96–101. https://doi.org/10.1016/j.oraloncology.2005.06.018 CrossRefPubMedGoogle Scholar
- 12.Huang SF, Kang CJ, Lin CY, Fan KH, Yen TC, Wang HM, Chen IH, Liao CT, Cheng AJ, Chang JT (2008) Neck treatment of patients with early stage oral tongue cancer: comparison between observation, supraomohyoid dissection, and extended dissection. Cancer 112(5):1066–1075. https://doi.org/10.1002/cncr.23278 CrossRefPubMedGoogle Scholar
- 14.Corlette TH, Cole IE, Albsoul N, Ayyash M (2005) Neck dissection of level IIb: is it really necessary? Laryngoscope 115(9):1624–1626. https://doi.org/10.1097/01.mlg.0000173154.92581.c5 CrossRefPubMedGoogle Scholar
- 15.Elsheikh MN, Mahfouz ME, Elsheikh E (2005) Level IIb lymph nodes metastasis in elective supraomohyoid neck dissection for oral cavity squamous cell carcinoma: a molecular-based study. Laryngoscope 115(9):1636–1640. https://doi.org/10.1097/01.mlg.0000176540.33486.c3 CrossRefPubMedGoogle Scholar
- 17.De Zinis LO, Bolzoni A, Piazza C, Nicolai P (2006) Prevalence and localization of nodal metastases in squamous cell carcinoma of the oral cavity: role and extension of neck dissection. Eur Arch Otorhinolaryngol 263(12):1131–1135. https://doi.org/10.1007/s00405-006-0128-5 CrossRefPubMedGoogle Scholar
- 19.Abe M, Murakami G, Noguchi M, Yajima T, Kohama GI (2003) Afferent and efferent lymph-collecting vessels of the submandibular nodes with special reference to the lymphatic route passing through the mylohyoid muscle. Head Neck 25(1):59–66. https://doi.org/10.1002/hed.10188 CrossRefPubMedGoogle Scholar
- 27.Chen TC, Wang CP, Ko JY, Yang TL, Hsu CW, Yeh KA, Chang YL, Lou PJ (2013) The impact of perineural invasion and/or lymphovascular invasion on the survival of early-stage oral squamous cell carcinoma patients. Ann Surg Oncol 20(7):2388–2395. https://doi.org/10.1245/s10434-013-2870-4 CrossRefPubMedGoogle Scholar
- 29.Lim YC, Lee JS, Koo BS, Kim SH, Kim YH, Choi EC (2006) Treatment of contralateral N0 neck in early squamous cell carcinoma of the oral tongue: elective neck dissection versus observation. Laryngoscope 116(3):461–465. https://doi.org/10.1097/01.mlg.0000195366.91395.9b CrossRefPubMedGoogle Scholar
- 30.Chen MM, Harris JP, Hara W, Sirjani D, Divi V (2016) Association of postoperative radiotherapy with survival in patients with N1 oral cavity and oropharyngeal squamous cell carcinoma. JAMA Otolaryngol Head Neck Surg 142(12):1224–1230. https://doi.org/10.1001/jamaoto.2016.3519 CrossRefPubMedGoogle Scholar
- 32.Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefebvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M, European Organization for R, Treatment of Cancer T (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350(19):1945–1952. https://doi.org/10.1056/NEJMoa032641 CrossRefPubMedGoogle Scholar
- 33.Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK, Radiation Therapy Oncology Group I (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350(19):1937–1944. https://doi.org/10.1056/NEJMoa032646 CrossRefPubMedGoogle Scholar