Lingual lymph node occurrence and metastasis in early-stage tongue cancer: An indicator for aggressive excision

Effective management of early-stage tongue cancer remains challenging because of the high risk of locoregional recurrence. This study evaluated the impact of lingual lymph node (LLN) dissection on the local recurrence rate, overall survival (OS), and disease-free survival (DFS). A retrospective analysis was conducted on 162 patients with early-stage (cT1-T2) squamous cell carcinoma (SCC) of the tongue treated between June 2014 and November 2022 at the School and Hospital of Stomatology, Wuhan University. The patients were categorized into two groups based on whether they underwent LLN dissection. Demographic and clinical data were compared, and OS and DFS were estimated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify predictors of outcomes. Of 162 patients (106 males and 56 females), 87 (54%) underwent LLN dissection, while 75 (46%) did not. The data only showed a positive correlation in improving OS and DFS with LLN dissection, without statistically significant differences between two groups. However, in the LLN dissection group, patients with LLN involvement (occurrence or metastasis) had significantly worse OS and DFS than those without LLN involvement. Univariate and multivariate analyses confirmed that the presence or metastasis of LLNs was an independent risk factor for OS and DFS. The occurrence or metastasis of LLNs is a critical predictor of survival outcomes in patients with early-stage tongue cancer. Detection of LLN involvement during surgery should prompt consideration of more extensive excision, such as in-continuity neck dissection, to potentially improve patient outcomes.