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

Ann Surg Oncol. 2013 Oct;20(11):3575-81. doi: 10.1245/s10434-013-3044-0. Epub 2013 Jun 18.


Background: 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-).

Methods: 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.

Results: 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.

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

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / mortality*
  • Carcinoma, Squamous Cell / secondary*
  • Female
  • Follow-Up Studies
  • Humans
  • International Agencies
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Mouth Neoplasms / mortality*
  • Mouth Neoplasms / pathology*
  • Neck Dissection / mortality*
  • Neoplasm Staging
  • Prognosis
  • Retrospective Studies
  • Survival Rate