Risk-Stratified Management of the Clinically Node-Negative Neck in Early-Stage Oral Squamous Cell Carcinoma: Elective Neck Dissection versus Watch-and-Wait with Therapeutic Dissection
A partir d'une revue systématique de la littérature publiée jusqu'en janvier 2026, cette étude compare les effets, sur la survie et en fonction du risque de récidive ganglionnaire, d'un curage ganglionnaire prophylactique et d'une surveillance active avec curage ganglionnaire thérapeutique pour un carcinome épidermoïde de la cavité buccale de stade précoce
Objective: To evaluate the optimal management of the clinically node-negative (cN0) neck in early-stage (T1–T2) oral squamous cell carcinoma (OSCC) by comparing initial elective neck dissection (END) versus a Watch & Wait (W&W) approach with therapeutic neck dissection (TND) upon nodal relapse.
Data Sources: Studies comparing END versus W&W/TND in T1–T2 cN0 OSCC patients were searched on PubMed till January 2026. PET imaging data were also assessed for nodal staging and surveillance.
Review Methods: Studies comparing END versus W&W/TND in T1–T2 cN0 OSCC patients were searched on PubMed up to January 2026. This comprehensive systematic review without meta-analysis (SWiM) qualitatively synthesized data regarding key outcomes: overall survival (OS), disease-specific survival (DFS), disease-free survival (DFS), nodal recurrence rates, and treatment-related morbidity. Effect estimates from landmark clinical trials and meta-analyses were evaluated to establish a risk-stratified framework.
Results: END demonstrated improved 3-year OS (80.0% vs. 67.5%; HR 0.64, P=0.01) and DFS (69.5% vs. 45.9%; P<0.001) compared to TND, alongside significantly lower nodal recurrence (15.1% vs. 41.5%; OR 0.25, P<0.00001). In low-risk patients (T1 tumors, DOI <4 mm, well-differentiated histology), a strict W&W protocol incorporating operator-dependent ultrasound, fine-needle aspiration cytology (FNAC), and PET surveillance achieved comparable DSS.
Conclusion: END provides superior survival and regional control in higher-risk T1–T2 cN0 OSCC. Conversely, a risk-stratified W&W strategy incorporating multimodal surveillance or staging via sentinel lymph node biopsy (SLNB) is highly effective for select low-risk, compliant patients, optimizing oncologic outcomes while minimizing treatment-related morbidity.
European Journal of Surgical Oncology , résumé, 2026