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


Authors: Mizrachi, A.; Migliacci, J. C.; Montero, P. H.; McBride, S.; Shah, J. P.; Patel, S. G.; Ganly, I.
Article Title: 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. © 2018 Elsevier Ltd
Keywords: radiotherapy; observation; salvage surgery; elective neck dissection; oral squamous cell carcinoma; neck recurrence
Journal Title: Oral Oncology
Volume: 78
ISSN: 1368-8375
Publisher: Elsevier Inc.  
Date Published: 2018-03-01
Start Page: 94
End Page: 101
Language: English
DOI: 10.1016/j.oraloncology.2018.01.020
PROVIDER: scopus
PMCID: PMC5836807
PUBMED: 29496065
DOI/URL:
Notes: Article -- Export Date: 2 April 2018 -- Source: Scopus
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MSK Authors
  1. Snehal G Patel
    301 Patel
  2. Ian Ganly
    255 Ganly
  3. Jatin P Shah
    566 Shah
  4. Sean Matthew McBride
    134 McBride