{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:58:29Z","timestamp":1791478709545,"version":"4.3.4"},"reference-count":37,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2024,11,22]],"date-time":"2024-11-22T00:00:00Z","timestamp":1732233600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Oral cavity squamous-cell carcinoma is among the most frequent head and neck neoplasms. Early-stage T1\/T2N0 accounts for 40\/45% of new diagnoses. Of these, about 30% of cases hide occult metastases in the neck. The management of clinically N0 neck is of paramount importance and is still being debated. Methods: The medical records of patients with a clinical diagnosis of early-stage T1-T2N0 carcinoma of the oral cavity between 2011 and 2021 were retrospectively analysed. The inclusion criteria were complete medical and radiological records, pT1-2 pathology staging, and a minimum follow-up of 24 months. Biographical, management, and survival data were analysed using IBM SPSS Statistics [28.0.1.1]; IBM Corp., Armonk, NY, USA). Results: A total of 121 patients met the inclusion criteria. The tongue was the most affected site, with 52 cases. All patients underwent resection of the primary tumour; for neck management, 47 (38.8%) underwent elective neck dissection, 36 underwent follow-up, and 11 underwent sentinel lymph node biopsy. A total of 59 cases were staged as T1 and 62 as T2; in 97 (80.2%) cases, the neck was confirmed as N0; in 10 (8.3%), N1; in 1 case, N2a; in 8, N2b; in 2, N2c; and in 3, N3b. The mean DOI was 4.8 mm. In a Cox regression, a statistically significant association was shown between overall survival and pN staging (p &lt; 0.05). Kaplan\u2013Meier analysis showed a statistically significant difference between different regimens of management of the neck in terms of overall survival, disease-free survival, and disease-specific survival in favour of elective neck dissection and sentinel lymph node biopsy compared to watchful policy (p &lt; 0.05). Conclusions: Elective neck dissection and sentinel lymph node biopsy proved to be safe and oncologically effective in the treatment of clinically N0 early-stage oral carcinoma.<\/jats:p>","DOI":"10.3390\/jcm13237067","type":"journal-article","created":{"date-parts":[[2024,11,22]],"date-time":"2024-11-22T10:17:23Z","timestamp":1732270643000},"page":"7067","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Management of Clinically Negative Neck in Early-Stage (T1-2N0) Oral Squamous-Cell Carcinoma (OSCC): Ten Years of a Single Institution\u2019s Experience"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5756-219X","authenticated-orcid":false,"given":"Danilo","family":"Di Giorgio","sequence":"first","affiliation":[{"name":"Department of Odontostomatological and Maxillofacial Sciences, La Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6235-9754","authenticated-orcid":false,"given":"Marco","family":"Della Monaca","sequence":"additional","affiliation":[{"name":"Department of Odontostomatological and Maxillofacial Sciences, La Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Nocini","sequence":"additional","affiliation":[{"name":"Unit of Otolaryngology, Head and Neck Department, University of Verona, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Battisti","sequence":"additional","affiliation":[{"name":"Department of Odontostomatological and Maxillofacial Sciences, La Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica Orsina","family":"Ferri","sequence":"additional","affiliation":[{"name":"Department of Odontostomatological and Maxillofacial Sciences, La Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3713-4470","authenticated-orcid":false,"given":"Paolo","family":"Priore","sequence":"additional","affiliation":[{"name":"Department of Odontostomatological and Maxillofacial Sciences, La Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Terenzi","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentino","family":"Valentini","sequence":"additional","affiliation":[{"name":"Department of Odontostomatological and Maxillofacial Sciences, La Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.oraloncology.2018.10.013","article-title":"Oral Cancers: Current Status","volume":"87","author":"Vaish","year":"2018","journal-title":"Oral Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Di Spirito, F., Di Palo, M.P., Folliero, V., Cannat\u00e0, D., Franci, G., Martina, S., and Amato, M. (2023). Oral Bacteria, Virus and Fungi in Saliva and Tissue Samples from Adult Subjects with Oral Squamous Cell Carcinoma: An Umbrella Review. Cancers, 15.","DOI":"10.3390\/cancers15235540"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"93","DOI":"10.3322\/caac.21388","article-title":"The Eighth Edition AJCC Cancer Staging Manual: Continuing to Build a Bridge from a Population-Based to a More \u201cPersonalized\u201d Approach to Cancer Staging","volume":"67","author":"Amin","year":"2017","journal-title":"CA A Cancer J. Clin."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1016\/j.otc.2012.06.016","article-title":"Evidence-Based Practice: Management of the Clinical Node-Negative Neck in Early-Stage Oral Cavity Squamous Cell Carcinoma","volume":"45","author":"Monroe","year":"2012","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1001\/jamaoto.2016.1281","article-title":"Elective Neck Dissection vs. Observation in Early-Stage Squamous Cell Carcinoma of the Oral Tongue With No Clinically Apparent Lymph Node Metastasis in the Neck: A Systematic Review and Meta-Analysis","volume":"142","author":"Yehuda","year":"2016","journal-title":"JAMA Otolaryngol.-Head Neck Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1002\/cncr.2820690526","article-title":"Prognostic Factors for Survival and Tumor Control in Cervical Lymph Node Metastases from Head and Neck Cancer. A Multivariate Study of 492 Cases","volume":"69","author":"Cerezo","year":"1992","journal-title":"Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1002\/(SICI)1097-0347(199909)21:6<517::AID-HED4>3.0.CO;2-C","article-title":"Improved Survival for Patients with Clinically T1\/T2, N0 Tongue Tumors Undergoing a Prophylactic Neck Dissection","volume":"21","author":"Haddadin","year":"1999","journal-title":"Head Neck"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1002\/hed.20988","article-title":"Elective Neck Dissection for the Management of the N0 Neck in Early Cancer of the Oral Tongue: Need for a Randomized Controlled Trial","volume":"31","author":"Siddachari","year":"2009","journal-title":"Head Neck"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"TPS6093","DOI":"10.1200\/JCO.2021.39.15_suppl.TPS6093","article-title":"NRG Oncology HN006: Randomized Phase II\/III Trial of Sentinel Lymph Node Biopsy versus Elective Neck Dissection for Early-Stage Oral Cavity Cancer","volume":"39","author":"Lai","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1848","DOI":"10.1093\/annonc\/mdw272","article-title":"Best Practice Guidelines in the Psychosocial Management of HPV-Related Head and Neck Cancer: Recommendations from the European Head and Neck Cancer Society\u2019s Make Sense Campaign","volume":"27","author":"Reich","year":"2016","journal-title":"Ann. Oncol."},{"key":"ref_11","first-page":"11884","article-title":"Essentials of Oral Cancer","volume":"8","author":"Rivera","year":"2015","journal-title":"Int. J. Clin. Exp. Pathol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Savino, G., Piccinni, F., Pagliara, M.M., Sammarco, M.G., Caputo, C.G., Moro, A., Barbera, G., Tagliaferri, L., Fionda, B., and Schinzari, G. (2022). Multidisciplinary Ocular and Periocular Cancers Meetings: Implementation in a Tertiary Referral Center and Analysis over a 12-Months Period. BMC Ophthalmol., 22.","DOI":"10.1186\/s12886-022-02694-3"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.oraloncology.2008.06.002","article-title":"Global Epidemiology of Oral and Oropharyngeal Cancer","volume":"45","author":"Warnakulasuriya","year":"2009","journal-title":"Oral Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"105451","DOI":"10.1016\/j.oraloncology.2021.105451","article-title":"Overview of Oral Cavity Squamous Cell Carcinoma: Risk Factors, Mechanisms, and Diagnostics","volume":"121","author":"Chamoli","year":"2021","journal-title":"Oral Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3575","DOI":"10.1245\/s10434-013-3044-0","article-title":"Clinical Nodal Stage Is a Significant Predictor of Outcome in Patients with Oral Cavity Squamous Cell Carcinoma and Pathologically Negative Neck Metastases: Results of the International Consortium for Outcome Research","volume":"20","author":"Amit","year":"2013","journal-title":"Ann. Surg. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/j.jcms.2020.06.004","article-title":"Management of the Clinically N0 Neck in Early-Stage Oral Squamous Cell Carcinoma (OSCC). An EACMFS Position Paper","volume":"48","author":"Vassiliou","year":"2020","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1002\/hed.21505","article-title":"Management of the Clinically Negative Neck in Early-Stage Head and Neck Cancers after Transoral Resection","volume":"33","author":"Rodrigo","year":"2011","journal-title":"Head. Neck"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1007\/s00405-008-0715-8","article-title":"Detection of Lymph Node Micrometastases in Patients with Squamous Carcinoma of the Head and Neck","volume":"265","author":"Ferlito","year":"2008","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2524","DOI":"10.1016\/j.joms.2007.03.010","article-title":"Positron Emission Tomography\/Computerized Tomography (PET\/CT) Scanning for Preoperative Staging of Patients with Oral\/Head and Neck Cancer","volume":"65","author":"Nahmias","year":"2007","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.coms.2008.02.002","article-title":"Management of the N0 Neck in Oral Squamous Cell Carcinoma","volume":"20","author":"Cheng","year":"2008","journal-title":"Oral Maxillofac. Surg. Clin. N. Am."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1038\/s41416-019-0587-2","article-title":"Nationwide Randomised Trial Evaluating Elective Neck Dissection for Early Stage Oral Cancer (SEND Study) with Meta-Analysis and Concurrent Real-World Cohort","volume":"121","author":"Hutchison","year":"2019","journal-title":"Br. J. Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"104661","DOI":"10.1016\/j.oraloncology.2020.104661","article-title":"Elective Neck Dissection versus Observation for Early-Stage Oral Squamous Cell Carcinoma: Systematic Review and Meta-Analysis","volume":"105","author":"Oh","year":"2020","journal-title":"Oral Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1200\/JCO.2008.20.8777","article-title":"Sentinel Lymph Node Biopsy Accurately Stages the Regional Lymph Nodes for T1-T2 Oral Squamous Cell Carcinomas: Results of a Prospective Multi-Institutional Trial","volume":"28","author":"Civantos","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1245\/s10434-008-0150-5","article-title":"Positive Sentinel Lymph Nodes Are a Negative Prognostic Factor for Survival in T1-2 Oral\/Oropharyngeal Cancer-a Long-Term Study on 103 Patients","volume":"16","author":"Stefenelli","year":"2009","journal-title":"Ann. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1001\/archotol.128.11.1287","article-title":"The Use of Sentinel Node Biopsy to Upstage the Clinically NO Neck in Head and Neck Cancer","volume":"128","author":"Ross","year":"2002","journal-title":"Arch. Otolaryngol.-Head Neck Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3181","DOI":"10.1007\/s00405-020-06538-y","article-title":"What Is the Role of Sentinel Lymph Node Biopsy in the Management of Oral Cancer in 2020?","volume":"278","author":"Civantos","year":"2021","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"104746","DOI":"10.1016\/j.oraloncology.2020.104746","article-title":"Why SLNB Procedure Is Not Currently Used in Early Stage Oral Squamous Cell Carcinoma?","volume":"109","author":"Terenzi","year":"2020","journal-title":"Oral Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2777","DOI":"10.1016\/j.ejca.2015.08.023","article-title":"Sentinel European Node Trial (SENT): 3-Year Results of Sentinel Node Biopsy in Oral Cancer","volume":"51","author":"Schilling","year":"2015","journal-title":"Eur. J. Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"104740","DOI":"10.1016\/j.oraloncology.2020.104740","article-title":"Lymph Node Yield and Lymph Node Ratio in Oral Cavity and Oropharyngeal Carcinoma: Preliminary Results from a Prospective, Multicenter, International Cohort","volume":"107","author":"Iocca","year":"2020","journal-title":"Oral Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.1002\/lary.26545","article-title":"Minimum Lymph Node Yield in Elective Level I-III Neck Dissection","volume":"127","author":"Pou","year":"2017","journal-title":"Laryngoscope"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ionna, F., Pavone, E., Aversa, C., Maffia, F., Spinelli, R., Carraturo, E., Salzano, G., Maglitto, F., Sarcinella, M., and Fusco, R. (2024). Sentinel Lymph Node Biopsy (SLNB) for Early-Stage Head and Neck Squamous-Cell Carcinoma of the Tongue: Twenty Years of Experience at I.N.T. \u201cG.Pascale\u201d. Cancers, 16.","DOI":"10.3390\/cancers16061153"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ijom.2023.08.004","article-title":"Management of Clinically Node-Negative Early-Stage Oral Cancer: Network Meta-Analysis of Randomized Clinical Trials","volume":"53","author":"Alkhutari","year":"2024","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.1097\/SCS.0000000000008472","article-title":"The Use of Scapular Bone Flaps during Head-and-Neck Reconstruction: Functional, Orthopedic, and Quality of Life Analyses of Flap-Harvest-Related Deficits","volume":"33","author":"Valentini","year":"2022","journal-title":"J. Craniofac. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.bjoms.2024.07.001","article-title":"Bone-Flap-Harvest-Related Donor Site Morbidity in Reconstructive Jaw Microsurgery: Retrospective Analysis Based on 220 Patients over a Ten-Year Period","volume":"62","author":"Nocini","year":"2024","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Moratin, J., Zittel, S., Horn, D., Behnisch, R., Ristow, O., Engel, M., Hoffmann, J., Freier, K., and Freudlsperger, C. (2023). Free-Flap Reconstruction in Early-Stage Squamous Cell Carcinoma of the Oral Cavity\u2014A Prospective Monocentric Trial to Evaluate Oncological Outcome and Quality of Life. J. Clin. Med., 12.","DOI":"10.3390\/jcm12144833"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"139","DOI":"10.23736\/S2724-6329.21.04597-6","article-title":"Reconstruction of the Mandibular Symphysis: Pilot Study Compares Three Different Flaps","volume":"71","author":"Barbera","year":"2022","journal-title":"Minerva Dent. Oral Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2943","DOI":"10.1002\/hed.27192","article-title":"The T-Shaped FST Pharyngoplasty Step-by-Step Closure Technique","volume":"44","author":"Petruzzi","year":"2022","journal-title":"Head Neck"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/23\/7067\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:37:45Z","timestamp":1760114265000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/23\/7067"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,22]]},"references-count":37,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["jcm13237067"],"URL":"https:\/\/doi.org\/10.3390\/jcm13237067","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,22]]}}}