Elective vs therapeutic neck dissection in node-negative oral cancer (Tata Memorial)
A Tata Memorial trial ended a 50-year debate by showing that removing the neck lymph nodes at the first operation for early mouth cancer raises three-year survival from about two-thirds to four-fifths.
Overview
596 patients were enrolled and 500 analysed (245 elective, 255 therapeutic) with a median follow-up of 39 months. There were 81 recurrences and 50 deaths with elective dissection against 146 recurrences and 79 deaths with therapeutic dissection; 3-year overall survival was 80.0% versus 67.5% (hazard ratio 0.64; 95% CI 0.45-0.92; P=0.01) and disease-free survival 69.5% versus 45.9% (P<0.001), with adverse events in 6.6% versus 3.6%. Presented in the ASCO plenary and published in NEJM, it changed guidelines worldwide and showed that Indian centres, with their very large oral cancer volumes, can settle questions Western centres cannot.
- 80 vs 67.5 out of 100 alive at 3 years with Elective neck dissection compared with Therapeutic neck dissection; 12.5 more per 100.
- Roughly one extra person helped for every 8 treated. That is a rough figure taken from the two percentages, not a guarantee for any one person.
- Put another way, the treated group had about 36 percent lower chance of the event at any given time (hazard ratio 0.64, likely range 0.45 to 0.92).
- Overall survival counts deaths from any cause, so it is the most direct measure of whether a treatment helps people live longer.
- These results apply to the people the trial enrolled: Early-stage (T1-T2) node-negative oral squamous cell cancer: elective neck dissection at primary surgery vs watchful waiting with therapeutic dissection at nodal relapse. People in a different situation may not see the same effect.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
596 participants enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| 3-year overall survivalprimary | Elective neck dissection | 245 | 80% | 0.64 (0.45–0.92) | 0.01 | link |
| Therapeutic neck dissection | 255 | 67.5% |
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