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Purpose of the study. To evaluate the impact of different management strategies for regional nodal metastases on survival in patients with localized oral cavity cancer (cT1–2N0M0), based on data from the population-based cancer registry of Arkhangelsk Oblast and Nenets Autonomous Okrug (PCR AO and NAO) over the period 2010–2024. Patients and methods . A population-based retrospective cohort study was conducted including 204 patients from the Population-Based Cancer Registry of the Arkhangelsk Region and the Nenets Autonomous Okrug. According to the treatment strategy chosen, patients were allocated to four groups: 1) radical surgery of the primary tumor with prophylactic neck lymph node dissection (n = 63); 2) radical surgery of the primary tumor with neck lymph node dissection followed by adjuvant radiation/chemoradiation therapy (n = 38); 3) radiation/chemoradiation therapy as a standalone treatment (n = 69); 4) radical surgery directed to the primary tumor only, without regional lymph node treatment (n = 34). Survival analysis was performed using the Kaplan–Meier method, the log-rank test, and the Cox proportional hazards regression model. Results . The 5‑year cancer-specific survival rate in the overall cohort was 70.8 % (95 % CI, 63.2–77.1 %). After adjustment for stage, age, sex, morphology, place of residence, and calendar period, the surgery group with elective neck dissection demonstrated the most favorable prognosis. Compared with this reference group, omission of regional lymph node treatment was associated with a 2.9‑fold increase in the risk of death (HR = 2.90; 95 % CI, 1.01–8.37; p = 0.049), while definitive radiotherapy as a standalone modality was associated with a 3.24‑fold increase (HR = 3.24; 95 % CI, 1.42–7.38; p = 0.005). The risk in the adjuvant radiotherapy group did not differ significantly from that in the reference group (HR = 1.63; p = 0.276). Stage II disease (HR = 2.72; p = 0.013) and age 50–69 years (HR = 1.99; p = 0.023) were independent adverse prognostic factors. Conclusion . The results of this population based study demonstrate that radical surgery of the primary tumor combined with prophylactic neck lymph node dissection is the optimal treatment strategy for patients with Stage I–II oral cavity cancer. Omission of regional lymph node treatment or the use of radiation therapy as a standalone method in routine clinical practice are associated with a statistically significant increase in the risk of disease specific mortality.