Background Occult nodal disease occurs in up to 30% of patients with oral cavity squamous cell carcinoma (OCSCC). This study aimed to identify the prevalence and the predictive factors of occult nodal disease in OCSCC patients with a clinically negative (N0) neck.
Methods All patients with OCSCC with a clinically N0 neck, undergoing elective neck dissection, between 2009 to 2021 at Hutt Hospital were identified from our Head and Neck Database. Patients with occult metastasis were identified and univariate analysis was performed to identify risk factors of occult metastasis including patient demographics and tumour characteristics.
Results Of 173 patients identified, 40 (23.1%) had occult nodal disease. Increased pathological stage of the primary tumour (pT stage) was associated with an increased risk of occult neck metastasis, nearing statistical significance (OR 1.31, 95% CI 0.98-1.75, p=0.071). Perineural invasion (PNI) was associated with an increased risk of occult metastasis although this was not-statistically significant (OR 1.77, 95% CI 0.83-3.8, p=0.142). Patient demographics including gender, smoking status, alcohol use, deprivation score and comorbidities were not statistically significant risk factors for occult nodal disease.
Conclusion 23.1% of patients undergoing an elective neck dissection for OCSCC had occult metastatic neck disease. Increased pT stage was associated with an increased risk of occult nodal disease. Presence of PNI, may be a predictive factor for occult nodal disease, however this was not statistically significant. No patient demographic feature was an independent risk factor for occult nodal metastasis. Larger cohort studies are warranted to further explore prognostic factors for occult nodal disease in OCSCC.