This study establishes specific lymph node dissection adequacy thresholds for patients with oral squamous cell carcinoma (OSCC) following neoadjuvant immunochemotherapy. The findings indicate that achieving a yield of ≥20 nodes in unilateral dissection or an average of ≥18 nodes per side in bilateral dissection is associated with significantly better overall survival.
Background
The adequacy of lymph node dissection following neoadjuvant immunotherapy combined with chemotherapy for locally advanced OSCC has not been well-defined. This study aims to provide clarity on the necessary thresholds for lymph node dissection adequacy.
Data Highlights
Dissection Type
Threshold
Adjusted Hazard Ratio (OS)
Unilateral (LND-Un)
≥20 nodes
2.42
Bilateral (LND-Bi)
≥18 nodes per side
2.29
Key Findings
The optimal threshold for unilateral lymph node dissection is ≥20 total lymph nodes.
The optimal threshold for bilateral lymph node dissection is an average of ≥18 nodes per side.
Inadequate lymph node dissection is associated with worse overall survival (OS) and disease-free survival (DFS).
Inadequate dissection correlates with a higher risk of major complications in unilateral dissection.
The findings were validated in an independent cohort.
Clinical Implications
Surgeons should aim to achieve the established lymph node dissection thresholds to improve survival outcomes in patients with OSCC undergoing neoadjuvant immunotherapy. These benchmarks can serve as a guide for surgical quality assessment and decision-making in clinical practice.
Conclusion
This study provides evidence-based thresholds for lymph node dissection adequacy that are associated with improved survival outcomes in OSCC.
