[Neck treatment strategy for pathologically node positive tongue squamous cell carcinoma.]

Area of Science:

• Oncology
• Head and Neck Surgery
• Cancer Research

Background:

• Pathologically node-positive (pN+) tongue squamous cell carcinoma (SCC) presents a significant risk for neck recurrence.
• Understanding the patterns of cervical lymph node metastasis and recurrence is crucial for effective treatment strategies.

Purpose of the Study:

• To analyze factors related to neck recurrence in pN+ tongue SCC.
• To investigate the patterns of cervical lymph node metastasis and recurrence.
• To explore optimal neck treatment strategies for pN+ tongue SCC.

Main Methods:

• Retrospective review of clinical and follow-up data from 138 patients with pN+ oral tongue SCC (1991-2008).
• Analysis of metastatic and recurrent lymph node distribution.
• Statistical analysis of influencing factors on neck recurrence, including Kaplan-Meier and multivariate Cox analyses.

Main Results:

• Tumor stage (pT, pN, pTNM) and extracapsular spread (ECS) of lymph nodes were significantly associated with neck recurrence (P < 0.05).
• Multivariate analysis identified pTNM stage and ECS as independent prognostic factors.
• Metastatic and recurrent lymph nodes were predominantly located in ipsilateral levels I, II, and III (94.6% and 77.3% respectively).
• Postoperative radiation showed a trend towards reduced recurrence when ECS was present (P=0.076).
• No significant difference in recurrence rates was observed between modified radical neck dissection (MRND) and radical neck dissection (RND).

Conclusions:

• pT stage, pN stage, pTNM stage, and ECS are key factors influencing neck recurrence in pN+ tongue SCC.
• Postoperative radiation may be beneficial in reducing recurrence when ECS is present.
• Modified neck dissection (MRND) can be considered when non-lymphatic structures are uninvolved.
• Selective neck dissection (SND) is a viable option for pN+ tongue SCC due to the common involvement of ipsilateral levels I-III.