Even when removed neck lymph nodes contain no cancer, some patients face a higher risk of recurrence.
What did the study examine?
Researchers retrospectively analysed 1,094 patients with oral cavity squamous cell carcinoma treated surgically at four cancer centres. All had no tumour in the removed neck lymph nodes (pathological N0). The team, including Gustavo Nader Marta, developed a nomogram that combines tumour and surgical characteristics to estimate the risk of cancer returning locally or in the neck.
What were the main findings?
The model divided patients into four risk categories. In the intermediate- and high-risk groups, postoperative radiotherapy was associated with lower observed three-year local or regional recurrence. Rates were 19% with versus 28% without radiotherapy in the intermediate-risk group, and 22% versus 38% in the high-risk group.
What might this mean for care?
Lymph-node status is important but is not the only factor. Tumour characteristics, surgical margins, nerve invasion and other pathology findings can help a clinical team discuss recurrence risk alongside the possible benefits and side effects of radiotherapy. The proposed tool may inform future research on personalised decision-making.
Can this model decide treatment today?
No. The study was retrospective, so the associations do not prove a causal treatment benefit. The nomogram also had only moderate ability to distinguish risks (C-index 0.66). The authors emphasise the need for independent and prospective validation before routine clinical use.
Gau M, Su J, Huang SH, Alfaraj FA, Olson R, Marta GN, et al. Nomogram for Risk-Adaptive Estimation of the Locoregional Control Benefit Following Postoperative Radiation Therapy for Pathologic N0 Oral Cavity Cancer: A Retrospective Analysis. Int J Radiat Oncol Biol Phys. 2026;124(2):328–339. doi:10.1016/j.ijrobp.2025.09.011.
For education only. Research findings do not replace individual clinical advice.
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