Prevalence of Recurrence in Early Tongue Cancer T1 or T2 with or Without Neck Dissection

: Background: Patients with T1 T2 N0 mouth or tongue cancer that has been confirmed by a doctor may choose to have a neck dissection. Some say that nodal return of a T1 original tumor is well controlled, while others say that salvage is more often the exception than the rule. Objective: To determine the likelihood of recurrence in T1 or T2 early tongue carcinoma with or without neck dissection. Methods: The prospective cross-sectional clinical study was conducted from March 2021 to March 2023 at the Department of ENT and Head Neck Surgery, Combined Military Hospital, Dhaka. All 100 patients who presented with clinically determined T1 and T2 disease, as defined by the American Joint Committee on Cancer (AJCC), were treated at the Department of Otolaryngology of the Combined Military Hospital in Dhaka and underwent primary surgical resection of the tumor with or without neck dissection. The study eliminated cases of cancer involving the base of the tongue or recurring oral tongue cancer. Results: In the neck dissection group, 3(6%) experienced local recurrence, 2(4%) experienced regional recurrence, and 1 (2%) experienced both (local and regional recurrence). There will be no dissection. 10(20%) Local recurrence, 3 (6%), Regional recurrence, and 1 (2% combined local and regional recurrence). Recurrence was 4(8%) in the neck dissection group and 14(28%) in the no dissection group. Conclusion: In this study, the overall recurrence rate was 8% in neck dissection and 28% in no neck dissection. The overall recurrence rate in the no neck dissection group was significantly greater than in the neck dissection group.


Introduction:
The most important sign of survival for oral tongue squamous cell carcinoma (SCC) is the growth of regional neck node metastases.This is not only the main reason why treatment doesn't work, but also the best predictor of survival. 1Regional lymph node metastases in the neck are a key part of planning care for OSCC and the most important predictor of survival. 2T1-2 and no visible lymph nodes (cN0).OSCC is more likely to spread to the lymph nodes in the neck. 3,4,5 patients with T1 or T2 oral cancer, there is still some debate over the best way to treat a clinically negative neck.Patients with head and neck squamous cell carcinoma had the greatest tumor-related prognostic variation depending on the status of the cervical lymph node.Treatment of the neck is necessary for patients who have lymph node metastases.When entering the neck, whether to remove the main tumor or to restore the surgical defect, a neck dissection is necessary. 6rgical excision is the gold standard treatment for early stage oral tongue squamous cell carcinomas (SCC). 7It is not apparent, however, whether a patient with a clinically negative neck should opt for an elective neck dissection or simply be followed.Recurrence occurs in around 23% of cases of oral tongue cancer grade T1, and it is predominantly regional rather than local in nature. 8The prognosis following a recurrence is a contentious topic: There are those who report effective therapy of a T1 original tumor's nodal recurrence, while there are others who consider salvage to be more of an exception than the rule. 9en SCC of the oral tongue is found at an early stage, the decision to treat the neck is not made easily.Even though there are diagnostic and therapeutic reasons for primary neck dissection, surgical involvement, which lengthens the time of general anesthesia, is not without risk.It is important to know how elective neck dissection may affect the result of a patient.

Materials and Methods:
The prospective cross-sectional clinical study was carried out in the Department of ENT and Head Neck Surgery, Combined Military Hospital, Dhaka during March'2021 to March, 2023.All 100 patients treated at the Department of Otolaryngology of Combined Military Hospital, Dhaka with clinically determined T1 and T2 disease, as defined by the American Joint Committee on Cancer (AJCC), who underwent primary surgical resection of the tumor with or without neck dissection were included in this study.Cancers of the tongue base and recurrent oral cancer of the tongue were precluded from the study.The objective of the study is to ascertain gender, primary tumor stage, and pathological characteristics, including the presence of metastases in neck dissection specimens, if performed.For initial pathological analysis, all tissues were formalin-fixed and submitted for histology following standard overnight machine processing.Following treatment, tissues were encased in paraffin wax.The cassettes were subsequently sliced into 5-micron sections, mounted on glass slides, and stained with hematoxylin and eosin.A designated Head and Neck pathologist at the CMH, Dhaka reviewed cases and reported the presence of lymph node metastases.Patients with T1N0 SCC of the oral tongue who had a partial glossectomy with neck dissection were in the first group.Patients with T1 and T2 N0 SCC of the oral tongue who had a partial glossectomy without neck dissection were in the second group.The Chi-square and Fisher's exact tests were used to check the relationship between the variables and the presence of regional repetition.
Analysis was performed to determine prognostic factors of statistical significance.Differences were considered significant for P < 0.05 and all P values were two tailed.

Results:
Majority age group in both group 32(64%) were in neck dissection and 30(60%) were in no neck dissection, male were predominate 31(62%) male in neck dissection and 29(58%) in no neck dissection.Common stage was T1 33(66%) in neck dissection and 38(76%) in no neck dissection.These were not statistically significant (p<0.05).Among the 50 patients who was underwent neck dissection, 4 patients had subsequent isolated recurrent disease, 2 patients had isolated local recurrent disease in the neck, and 1 patients regional recurrence presented with the neck dissection, with a 2% overall loco-regional recurrence rate in this group.Among all the 50 patients who had not underwent neck dissection at the time of surgical resection of the primary tumor, 10 patients had isolated recurrent disease at the primary site, 3 patients had isolated regional recurrent disease in the neck, and 1 patient presented with recurrence at both the loco and regional no neck dissection, with a 28% overall loco-regional recurrence rate in this group.The

Discussion:
In this study, the majority of people in both groups were between the ages of 32 and 30.Most people in both groups were male, with 31 (62%) men in the neck dissection group and 29 (58%) men in the no neck dissection group.T1 was the most common stage, with 33 (66%) having a neck dissection and 38 (76%) not having one.That none of them were statistically important (p0.05).Mahieu et al. 10 found that the average age of the SLNB group was 62.03±11.97years and the average age of the END group was 61.98±12.77years.Most of the patients in the SLNB group (51.8%) and 197 of the patients in the END group (54.0%) were men.The difference between the two groups was not statistically important (p>0.05).The END cohort had a higher rate of cT2-staged tumors (p < 0.001) and a higher rate of tumors staged pT2 or higher (52.8 vs. 24.6%;p < 0.001).Sung et al. 11 found that there were a total of 84 patients split evenly between male and female participants in the partial glossectomy only group (PG group).Of these, 61 had initial tumors classified as T1, whereas 23 were classified as T2.T1 tumors were found in 9 of the 14 patients in the partial glossectomy with elective neck dissection (END) group, while T2 tumors were found in 5 of the patients.According to Peng et al. 12 , 64 were men, and 59 were women.Patients' ages at tumor removal were variable (27-92) with a mean of 56 years.
This study consists of 50 patients who had neck dissection.Out of those 50 cases, 4 had isolated recurrences, 2 had isolated local recurrences in the neck, and 1 had a regional recurrence at the time of the neck dissection, with 2% loco-regional recurrences.Of the 50 patients who had neck dissection when the primary tumor was removed, 10 had isolated recurrence at the primary site, 3 had isolated regional recurrence in the neck, and 1 had recurrence at both the loco and regional sites.This gives this group an overall loco-regional recurrence rate of 28%.Sung et al.  12 the overall rate of loco-regional recurrence was 20% among the 88 patients who underwent ipsilateral primary neck dissection.Of these patients, 8 developed isolated recurrent disease at the primary site, 7 developed isolated recurrent disease in the neck, and 3 presented with recurrence at both the primary and the neck.There was a 31% overall locoregional recurrence rate among the 35 patients who did not undergo neck dissection at the time of surgical resection of the primary tumor; 7 patients had isolated recurrence at the primary site, 2 patients presented with recurrence at both the primary and the neck.
The present study found that 33 (100%) of T1-stage patients who had neck dissection lived for 3 years, while 35 (92.1% of them) did not have neck dissection.T2 stage 13 with neck dissection (76.5%) and stage 10 without neck dissection (83.3%).The 5-year OS rate for all patients was 90.8%, and the DFS rate was 67.1%, according to Sung et al. 11 the 5-year DFS rates for T1 were 71.1% and for T2 they were 54.3%.For T1 patients, the 5-year DFS rate was 68.8% for the PG group and 77.8% for the END group.The 5year DFS rate for T2 cases was 51% and 60%, respectively.Liu et al. 13 showed that there was no statistical difference between the END and PG groups in terms of DFS or OS.Kligerman et al. 14 found that the 3-year mortality rate went up from 49% to 72% after a voluntary neck dissection.Keski-Santti et al. 15 also came to the conclusion that voluntary neck dissection had no big effect on overall survival.

Conclusion:
Study reports have suggested that nodal recurrence in early-stage oral tongue SCC occurs more commonly.Overall recurrence rate is higher in no neck dissection group in comparison to neck dissection group.Three years survival rate is also higher in early stage and neck dissection group.

Table I :
Baseline characteristics of the patients

Table II :
Recurrence according to site s= significant, p value reached from chi square test

Table III :
Survival rate within 3 years