{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T23:39:26Z","timestamp":1791848366984,"version":"4.3.4"},"reference-count":77,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T00:00:00Z","timestamp":1745193600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the survival benefit of elective neck dissection (END) over neck observation in surgically resected cT1\u20104 N0M0 head and neck spindle cell carcinoma (HNSpCC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The 2006 to 2018 hospital\u2010based National Cancer Database (NCDB).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with surgically resected cT1\u20104 N0M0 HNSpCC were selected. Linear, binary logistic, Kaplan\u2010Meier, and Cox proportional hazards regression models were implemented.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 815 patients satisfying inclusion criteria, a high proportion were male (72.4%) and white (86.0%) with disease of the larynx (43.8%) classified as high grade (87.7%) and cT1\u20102 (74.8%). In total, 235 (28.8%) patients underwent END. END utilization between 2006 and 2018 increased for cT1\u20102 disease (4.0% vs 30.5%, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.731) and for cT3\u20104 disease (15.4% vs 84.6%, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.606). In total, 58 (24.7%) ENDs detected occult nodal metastases (ONMs). The 5\u2010year overall survival (OS) of patients undergoing neck observation and END was 62% and 54%, respectively (<jats:italic>P<\/jats:italic>\u2009=\u2009.215). Among patients undergoing END, patients with ONM had worse 5\u2010year OS than those without ONM (38% vs 60%, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001). On multivariable Cox regression, END was not associated with OS (adjusted hazard ratio [aHR] 0.74, 95% CI 0.68\u20101.32, <jats:italic>P<\/jats:italic>\u2009=\u2009.735); ONM (hazard ratio [HR] 2.01, 95% CI 1.29\u20103.12, <jats:italic>P<\/jats:italic>\u2009=\u2009.002) was associated with worse OS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>END is performed in a high proportion (30%) of patients with cN0M0 HNSpCC but is not associated with higher OS. The rate of ONM approaching 25% and the association between ONM and worse OS, however, justify consideration of END in HNSpCC.<\/jats:p><jats:p><jats:bold>Level of Evidence:<\/jats:bold> 4.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.1265","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T09:35:31Z","timestamp":1745228131000},"page":"433-446","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Elective Neck Dissection in cT1\u20104 N0M0 Head and Neck Spindle Cell Carcinoma"],"prefix":"10.1002","volume":"173","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6428-2064","authenticated-orcid":false,"given":"Praneet C.","family":"Kaki","sequence":"first","affiliation":[{"name":"Sidney Kimmel Medical College Thomas Jefferson University Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman M.","family":"Patel","sequence":"additional","affiliation":[{"name":"Rutgers New Jersey Medical School Newark New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassaam S.","family":"Choudhry","sequence":"additional","affiliation":[{"name":"Rutgers New Jersey Medical School Newark New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason A.","family":"Brant","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"},{"name":"Department of Otolaryngology Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Brody","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"},{"name":"Department of Otolaryngology Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan M.","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania 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