ORIGINAL ARTICLE Cervical metastases behavior of T1–2 squamous cell cancer of the oral mucosa Keyvan Sagheb 1 & Sebastian Blatt 1 & Roman-Kia Rahimi-Nedjat 1 & Simone Eigenbrodt 1 & Bilal Al-Nawas 1 & Christian Walter 1 Received: 14 January 2016 /Accepted: 2 May 2016 # Springer-Verlag Berlin Heidelberg 2016 Abstract Objectives The clinical management of the neck of patients with early-stage oral squamous cell cancer (OSCC) is still controversially discussed in the current literature. This study analyzes histo-clinical factors influencing the occurrence of cervical lymph node metastases (CM). Materials and methods In a retrospective mono-center study, patients with a primary T1–2 OSCC between 2000 and 2014 were analyzed regarding histo-clinical parameters possibly influencing the CM rate and the outcome. Results Two hundred eighty-five patients (66 %) were male and 146 female (44 %), with a mean age of 60 ± 12 years at the time of diagnosis. Seventy-seven percent showed a positive risk profile (nicotine/alcohol) and 69 % underlying diseases. Forty-four percent of the patients were staged as T2 (30 % with CM). Advanced tumor size (T1 vs. T2) and grading (G1– 2 vs. G3) were statistically significantly (p < 0.001) associated with the occurrence of CM. The localization within the oral cavity, age, gender, risk profile, or underlying diseases had no influence on CM occurrence. During the follow-up, tumor size ( p = 0.001), CM ( p < 0.001), and tumor relapse (p < 0.001) were significantly associated with a worse outcome. Conclusions Early-stage OSCC showed aggressive lymphatic metastatic behavior that depends on the size and the grading of the tumor. Clinical relevance A watch-and-wait policy as the primary management for cN0 may likely be inferior to a selective neck dissection for this patient group and should only be considered for very small tumors with a good differentiation. Keywords Oral cancer . Head and neck cancer . Oral squamous cell carcinoma . Lymphatic metastasis Introduction With an annual incidence of approximately 300,000 cases worldwide, oral squamous cell cancer (OSCC) is rated as the sixth most common cancer [1]. The overall survival rates are still low, between 40 and 66 % [2, 3], with the tumor size and lymph node metastasis (CM) at the time of initial diagnosis as the most important clinical prognostic factors [4, 5] (Fig 1). The guideline’s conformal treatment includes, in addition to the surgical resection of the tumor with safe margins, an additional neck dissection (ND) even for a clinically negative neck [6]. The reason for this is the high rate of occult CM of approximately 25 % (range 5–45 %) [7–10] and because the clinical examination and radiological examination during the staging often cannot predict the absence of CM, with approx- imate false-negative and false-positive rates of 30 % [11]. Nevertheless, surgical management of the neck, especially for early-stage tumors, is still controversial due the fact that 70–80 % are pN0 and therefore theoretically over-treated [12, 13]. The establishment of risk scores based on clinical and histopathological risk characteristics could help to estimate the risk of developing CM for this patient group [9, 14, 15]. The objective of this study is to analyze the histo-clinical features which are easily accessible at the end of the preoper- ative clinical staging which may influence the risk for CM and the outcome. * Keyvan Sagheb keyvan.sagheb@unimedizin-mainz.de 1 Department of Oral and Maxillofacial Surgery—Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131 Mainz, Germany Clin Oral Invest DOI 10.1007/s00784-016-1845-9