Occult cervical metastasis of squamous cell carcinoma of tongue among CN0 patients and its treatment

Abstract

Objective: To explore the treatment of clinically negative neck (CN0) patients with squamous cell carcinoma of the tongue. Methods: 165 CN0 patients with squamous cell carcinoma of the tongue from 1985 to 2002 were investigated retrospectively. Parts of the patients staged at T₁, T₂ and T₃ underwent resection of primary lesion followed by neck observation, and other patients staged above T₂ or at T₁ but without follow-up were treated with elective neck dissection (END). All patients were followed up for more than 3 y or until their death. Results: Lymphatic metastasis was identified histologically after operation in 33 of 120 patients treated with END, and 9 of 45 patients treated with resection of primary lesion alone. The overall rate of occult lymphatic metastasis was 25.45%, which increased with the elevating of clinical T stage. The overall rate of neck uncontrolled death was 20.00% for observation group and 5.00% for END group, and significant difference was found between them (P<0.05). For T₁ patients in the two groups, the rate of neck uncontrolled death was 7.71% and 4.00% respectively, and no significance was found between them (P>0.05). When stage T₂ and T₃ were considered as middle stage together, significant difference (P<0.05) could be obtained between observation (70.00%) and END group (0%). Conclusion: The occult metastasis rate of squamous cell carcinoma of tongue increases with the elevating of clinical stage, and elective neck dissection could be considered for N0 patients staged over T₂ to improve neck control and survival rate; and regional resection alone of primary lesion could be considered for T1N0 patients to improve quality of life if closely followed up is conducted.