Neck Dissection Reduces Risk of Recurrence in Early‐Stage Oral Tongue Cancer

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BACKGROUND: Patterns of failure in early-stage oral tongue squamous cell carcinoma (OTSCC) managed with surgery alone remain understudied. METHODS: Retrospective cohort study from 2000 to 2022 at a single tertiary care center evaluated pT1-T2N0 OTSCC patients who underwent partial glossectomy with or without elective neck dissection (END), without any adjuvant therapy. Predictors of recurrence were analyzed via multivariate Cox proportional hazards model. RESULTS: The study included 201 OTSCC patients (131 pT1 and 70 pT2). Eighty patients (40%) underwent glossectomy alone; 121 (60%) underwent glossectomy with END. At a median follow-up of 56 months (IQR 23-82), 63 patients (31%) developed recurrence (21.4% local; 15.9% regional; 1% distant). Positive margins (HR 5.45 [1.9-15.4]), perineural invasion (HR 4.15 [1.8-9.9]), and increasing depth of invasion (DOI) (HR 1.32 [1.1-1.6]) were independently associated with recurrence. Upfront END reduced the risk of recurrence (HR 0.31 [95% CI: 0.15-0.6]), with benefit starting at tumor DOI 2 mm and greater. CONCLUSIONS: Upfront END decreases recurrence for pT1-T2N0 OTSCC treated with surgery alone starting at a DOI of 2 mm.

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