Neck observation versus elective neck dissection in management of clinical T1/2N0 oral squamous cell carcinoma: a retrospective study of 232 patients

Objective: The management of early-stage(cT1/2N0) oral squamous cell carcinoma(OSCC) remains a controversial issue. The aim of this study was to compare the clinical outcomes of neck observation(OBS) and elective neck dissection(END) in treating patients with cT1/2N0 OSCC.Methods: A total of 232 patients with cT1/2N0 OSCC were included in this retrospective study. Of these patients, 181 were treated with END and 51 with OBS. The survival curves of 5-year overall survival(OS), diseasespecific survival(DSS), and recurrence-free survival(RFS) rates were plotted using the Kaplan-Meier method for each group, and compared using the Log-rank test.Results: There was no significant difference in 5-year OS and DSS rates between END and OBS groups(OS:89.0% vs. 88.2%, P=0.906; DSS: 92.3% vs. 92.2%, P=0.998). However, the END group had a higher 5-year RFS rate than the OBS group(90.1% vs. 76.5%, P=0.009). Patients with occult metastases in OBS group(7/51) had similar 5-year OS rate(57.1% vs. 64.1%, P=0.839) and DSS rate(71.4% vs. 74.4%, P=0.982) to those in END group(39/181). In the regional recurrence patients, the 5-year OS rate(57.1% vs. 11.1%, P=0.011) and DSS rate(71.4% vs. 22.2%, P=0.022) in OBS group(7/51) were higher than those in END group(9/181).Conclusions: The results indicated that OBS policy could obtain the same 5-year OS and DSS as END. Under close follow-up, OBS policy may be an available treatment option for patients with clinical T1/2N0 OSCC.