Is Long-Term Follow-Up Mandatory for Stage I Oral Tongue Cancer?

The objective of this study was to analyze the outcomes and possible risk factors for late recurrence of pathologic stage I oral tongue squamous cell carcinomas (SCCs) in patients considered disease free at 3 years. This retrospective study evaluated all patients with pathologic stage I oral tongue cancer within a tertiary care center from 2003 through 2013 who had been followed for a minimum of 36 months. One hundred twelve patients met inclusion criteria for long-term analysis. Despite the high overall survival of 92.2% for true pT1N0M0 disease, initial surgery failed in 25 of 112 patients (22.3%) who developed late disease recurrence (>36-month follow-up) locally (19.6%; n = 22), regionally (4.4%; n = 5), or as second primary disease (11.6%; n = 13). Eleven patients (50%) who had local recurrence could be salvaged with a second surgery, requiring no further treatment (mean, 48.7 months). Projected 10-year disease-free survival and overall survival were 61 and 89%, respectively. Thirty-three percent (n = 3 of 9) of deaths occurred in long-term patients considered disease free at 36 months. Stage I tongue SCC is more common in women and is associated with pre-existing leukoplakia. Although overall survival is excellent, a high failure rate from local recurrence or a new second primary is seen over an extended period. Long-term follow-up is mandatory because local salvage rates are excellent if SCC is diagnosed early. Regional failure carries a poor prognosis.