Neck recurrence in clinically node-negative oral cancer: 27-year experience at a single institution

• Main Authors: Ganly, I. (Author), McBride, S. (Author), Migliacci, J.C (Author), Mizrachi, A. (Author), Montero, P.H (Author), Patel, S.G (Author), Shah, J.P (Author)
• Format: Article
• Language: English
• Published: Elsevier Ltd 2018
• Subjects: adjuvant chemoradiotherapy; adjuvant therapy; adolescent; Adolescent; adult; Adult; aged; Aged; Aged, 80 and over; antineoplastic agent; Article; cancer center; cancer patient; cancer prognosis; cancer recurrence; cancer surgery; cancer survival; Carcinoma, Squamous Cell; clinical outcome; cohort analysis; disease specific survival; Elective neck dissection; elective surgery; female; Female; follow up; gingiva; human; Humans; Kaplan Meier method; Kaplan-Meier Estimate; lymph node metastasis; lymph vessel metastasis; Lymphatic Metastasis; major clinical study; male; Male; middle aged; Middle Aged; Mouth Neoplasms; mouth squamous cell carcinoma; mouth tumor; neck cancer; neck dissection; Neck Dissection; Neck recurrence; Neoplasm Recurrence, Local; Observation; Oral squamous cell carcinoma; oral surgery; overall survival; palate; pathology; perineural invasion; primary tumor; priority journal; Radiotherapy; recurrence free survival; recurrent disease; Retrospective Studies; retrospective study; Salvage surgery; salvage therapy; smoking; squamous cell carcinoma; treatment failure; tumor recurrence; very elderly; young adult; Young Adult
• Online Access: View Fulltext in Publisher

 Objectives: Neck failure in patients with oral squamous cell carcinoma (OSCC) carries a poor outcome, yet the management of patients who initially present with clinically node-negative (cN0) neck is not clearly defined. Patients and methods: Retrospective review of patients with cN0 OSCC treated at Memorial Sloan Kettering Cancer Center from 1985 to 2012, focusing on rate, pattern and predictors of neck failure, salvage treatment, and survival outcomes. Results: Of 1,302 patients, 806 (62%) underwent elective neck dissection (END) and 496 (38%) had observation. 190 patients (15%) developed neck recurrence. Median follow-up was 58.5 months (range 1–343); 5-year neck recurrence-free survival (NRFS) was 85% and 80% for the END and observation group respectively (p =.06). Patients with neck failure had poorer outcomes than patients without neck failure (5-year overall survival, 37% vs. 74% [p <.001]; disease-specific survival [DSS], 41% vs. 91% [p <.001]). Independent predictors of neck failure were smoking, primary tumor subsite (hard palate and upper gum), and extranodal extension. 87% of patients underwent salvage treatment (END: 81.1%; observation: 94%). Salvage surgery with adjuvant (chemo) radiation had better DSS than surgery alone or nonsurgical salvage. Conclusions: In our cohort of patients with initially cN0 OSCC triaged to END vs. observation using clinical parameters, 15% developed neck failure. Salvage treatment was feasible in most cases but survival was poorer compared to patients without neck failure. Surgery followed by adjuvant (chemo) radiation resulted in the best outcome. © 2018 Elsevier Ltd