When Should Elective Neck Dissection Be Considered for Early‐Stage Oral Cavity Tumors? Insights From a Multicenter Study of 1109 Patients and Development of a Multiparametric Predictive Model

Background: Nodal metastases significantly affect prognosis in oral cavity squamous cell carcinoma (OCSCC). In early-stage OCSCC (cT1-T2 cN0), management of the clinically negative neck (cN0) remains controversial. Depth of invasion (DOI) is a key determinant for END, but other histopathological parameters, such as grading, perineural invasion (PNI), lymphovascular invasion (LVI), and worst pattern of invasion (WPOI), are emerging prognostic factors. Methods: This multicenter retrospective study analyzed 1109 patients with cT1-T2 cN0 OCSCC treated at 30 Italian hospitals since 2017. Data on histopathological parameters, tumor characteristics, and patient outcomes were collected via the REDCap platform. Simple and multivariable logistic regression models were developed to assess predictors of occult nodal metastases. Results: A total of 585 patients were clinically classified as cT1 tumors (53%), 503 as cT2 (45%), and cTis (1.9%). Of the 1109 patients, 193 (28%) had occult nodal metastases, with DOI, LVI, PNI, WPOI, and grading emerging as significant predictors. A predictive model integrating these variables demonstrated superior accuracy compared to a DOI-only model (AUROC comparison, p < 0.01). Conclusion: This study highlights the importance of incorporating multiple histopathological parameters into risk models for occult nodal metastases, overcoming the fixed DOI as a cutoff. The proposed predictive model offers a more precise method for guiding END in early-stage OCSCC, allowing individualized risk estimation.