Tumor Budding Is a Promising Indicator for Elective Neck Dissection in Node-Negative Early-Stage Oral Squamous Cell Carcinoma: A Retrospective Cohort Study

BackgroundCurrently, it is still under debate whether patients with early-stage oral cancers should be treated with elective neck dissection at the time of the primary surgery or with therapeutic neck dissection after cervical nodal relapse. Thus, it is urgent to develop a novel biomarker to stratify the patients with high risk of occult cervical node metastasis who should be treated with elective neck dissection. MethodsA total of 231 patients diagnosed with early-stage oral squamous cell carcinoma were retrospectively retrieved in this cohort study. Tumor budding was evaluated as International Tumor Budding Consensus Conference recommended. Overall and disease-free survivals were evaluated by the Kaplan-Meier method. Cox proportional hazards regression models were used to assess their prognostic value. Subgroup analysis was conducted, and both multiplicative interaction effects and additive interaction effects were assessed. ResultsAs expected, high tumor budding was associated with poorer prognosis, while elective neck dissection was linked to a better prognosis. After further subgrouping, we were surprised to find that elective neck dissection could significantly improve both overall survival and disease-free survival in patients with high tumor budding, and additive interaction was observed. However, there was no significant difference in overall survival for patients with low tumor budding. ConclusionEarly-stage clinical node-negative oral cancers patients with high tumor budding should be treated with elective neck dissection for better prognosis. The Watch and wait and therapeutic neck dissection strategies are still recommended for early-stage oral cancers patients with low tumor budding.