, Volume 20, Issue 11, pp 3575-3581
Date: 18 Jun 2013

Clinical Nodal Stage is a Significant Predictor of Outcome in Patients with Oral Cavity Squamous Cell Carcinoma and Pathologically Negative Neck Metastases: Results of the International Consortium for Outcome Research

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We aimed to study the importance of clinical N classification (cN) in a subgroup of patients with oral cavity squamous cell carcinoma (OSCC) and pathologically negative neck nodes (pN−).


A total of 2,258 patients from 11 cancer centers who underwent neck dissection for OSCC (1990–2011) had pN− disease. The median follow-up was 44 months. 5-year overall survival (OS), disease-specific survival (DSS), disease free survival, local control, locoregional control, and distant metastasis rates were calculated by the Kaplan–Meier method. cN classification and tumor, node, metastasis classification system staging variables were subjected to multivariate analysis.


A total of 345 patients were preoperatively classified as cN+ and 1,913 were classified as cN−. The 5-year OS and DSS of cN− patients were 73.6 and 82.2 %, respectively. The 5-year OS and DSS of cN+ patients were 64.9 and 76.9 %, respectively (p < 0.0001 each). A cN+ classification was a significant predictor of worse OS (p = 0.03) and DSS (p = 0.016), regardless of treatment, depth of invasion, or extent of neck dissection. cN classification was associated with recurrence-free survival (p = 0.01) and locoregional (neck and primary tumor) control (p = 0.004), but not with local (p = 0.19) and distant (p = 0.06) recurrence rates.


Clinical evidence of neck metastases is an independent predictor of outcome, even in patients with pN− nodes.