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

Abstract

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.

Keywords: Elective neck dissection; Neck recurrence; Observation; Oral squamous cell carcinoma; Radiotherapy; Salvage surgery.

Conflict of interest statement

Conflict of Interest Statement: None declared.

Copyright © 2018 Elsevier Ltd. All rights reserved.

Figures

Figure 1

(A) Initial management and outcomes of all patients, described by a flow diagram and (B) a Kaplan-Meier curve of neck recurrence–free survival.

Figure 1

(A) Initial management and outcomes of all patients, described by a flow diagram and (B) a Kaplan-Meier curve of neck recurrence–free survival.

Figure 2

(A) Anatomical illustration showing location and pattern of neck recurrence in patients in the observation and (B) elective neck dissection groups. Each percentage represents the percentage of patients with recurrence who recurred in that specific level of the neck.

Figure 3

Kaplan-Meier curves demonstrating the effect of neck recurrence on (A) disease-specific survival (DSS) and (B) overall survival (OS)

Figure 4

(A) Kaplan-Meier curves demonstrating neck recurrence–free survival (NRFS) stratified by pathological N (pN) stage and (B) the presence of extra capsular spread (ECS).

Figure 5

Kaplan-Meier curves demonstrating disease-specific survival (DSS) by salvage treatment modality.