Neck observation is appropriate in T1–2, cN0 oral squamous cell carcinoma without perineural invasion or lymphovascular invasion

摘要: Summary Objectives Management of cN0 neck, elective neck dissection (END) or observation, remains controversial for T1–2 oral squamous cell carcinoma (OSCC). To allow the safe observation it is mandatory to define predictors with high negative predictive value (NPV) cervical lymph node (LN) status. Materials and Methods Pathologic re-evaluation was performed in tumors 253 consecutive patients T1–2, OSCC. The roles pathologic parameters LN status guiding management were investigated. Results Cervical metastasis (LN+) occurred at a similar rate between END groups (20.8% vs. 22.2%, p = 0.807), indicating poor discriminatory by clinical judgment. Compared T classification, tumor thickness differentiation, PNI/LVI (perineural invasion/lymphovascular invasion) demonstrated highest NPV (85.5%). Hypothetically using guide management, dramatic reduction overtreatment could be achieved (54.2% 20.2%), minimal increase undertreatment (6.3% 9.9%). In without PNI LVI (PNI/LVI−), ultimate control (96.9% 96.3%, p = 1.000) 5-year disease-specific survival (91.1% 92.8%, p = 0.863) equivalent END. However, significantly higher incidence recurrence found (16.9% 6.5%, p = 0.031), 93.8% occurring within one year 73.3% being successfully salvaged. Conclusion Observation under close follow-up first appropriate OSCC LVI, achievement rates compared