Neck dissection in cN0 oral squamous cell carcinoma: a chance for immunotherapy

Elective neck dissection is the standard neck management for cT1-T2N0 oral squamous cell carcinoma (OSCC), but it carries a high risk of complications and overtreatment. Neoadjuvant immunotherapy has been less studied in early-stage OSCC, but recent evidence has emphasized that the absence of healthy lymph nodes may compromise the immune response, suggesting that the introduction of neoadjuvant immunotherapy in early-stage patients with healthier lymph nodes may be beneficial for treatment outcomes. This review explores the potential of neoadjuvant immunotherapy combinations and the watch-and-wait strategy as alternative approaches to neck management in early-stage OSCC, with the aim of achieving both optimal survival and quality of life. The current landscape of neck management and the immune function of lymph nodes are summarized, and the current evidence and potential advantages of neoadjuvant immunotherapy combinations in the treatment of early-stage OSCC are highlighted. Further evaluation of the efficacy of neoadjuvant immunotherapy combination in controlling occult metastases is needed to determine the potential survival benefits. In addition, the effectiveness of neoadjuvant immunotherapy in early-stage OSCC may be enhanced by the development of non-invasive lymph node diagnostics, clinical risk decision systems, and lymph node drug delivery systems.