Purpose: The study aimed to retrospectively identify the prognostic factors of surgically treated primary tongue squamous cell carcinoma (TSCC) cases and assess the benefits of surgical neck lymph node dissection (LND) in early- stage cancer. Methods: Patients with primary TSCC with pT1- 2N0 - 1M0 stage without distant metastasis who were treated with surgery during 2014-2016 at Xiangya Hospital, Central South University were included. Univariate and multivariate Cox models were constructed to explore prognostic factors of overall survival (OS), diseasefree survival (DFS), and local recurrence- free survival (LRFS). Sub - group analysis was used to assess the effect of adjuvant therapy and the prognostic value of LND for the early- stage patients. Results: In total, 440 patients met the inclusion criteria. During the follow- up period, the 5- year OS, DFS, were 84.4% and 70.0%, respectively. Univariate analysis showed that TNM stage, lymphovascular invasion (LVI), and/or perineural invasion (PNI), pathological differentiation, etc. were significant predictors of OS and DFS. Multivariate analysis showed that TNM stage and the degree of pathological differentiation were independent prognostic factors for all outcomes. Besides, the number of cervical LND could independently predict both DFS and LRFS while LVI/PNI were associated with DFS. And high- quality neck LND (>= 30) significantly improved DFS and LRFS for patients of pT1cN0M0 or stage I as compared to those without LND. Conclusions: TNM stage and pathological differentiation were crucial prognostic factors for postoperative patients with TSCC. Notably, high- quality cervical LND was beneficial for the improvement of DFS and LRFS for patients of pT1cN0M0 or stage I.