We evaluated predictive factors for cervical lymph node metastasis of tongue squamous cell carcinoma (SCC).We present a retrospective analysis of 90 patients with T1-2 N0 SCC who underwent primary excision as initial treatment without preoperative radiotherapy or chemotherapy. We examined the clinicopathologic factors (gender, age, clinical stage, surgical margin, grade of differentiation, lymphatic invasion, tumor depth of invasion, pattern of invasion [POI]) and immunohistochemical factors (vascular endothelial growth factor [VEGF]-A and VEGF-C expression) to predict the probability of lymph node metastasis.The local progression-free 5-year survival rate was 100%. Tumor depth of invasion (≥4 mm, P = .022), POI (score >4, P = .000), and VEGF-C expression (P = .008) were associated with the lymph node metastasis of tongue SCC in a multiple logistic regression analysis (odds ratios [ORs]: 5.075, 17.383, and 9.533, respectively).The local control rate of tongue SCC in the early stages has significantly improved as a result of development of surgical techniques. On the other hand, we believe that tumor depth of invasion (≥4 mm), POI, and VEGF-C expression all need to be considered in the preoperative and postoperative planning stages for tongue cancer treatment.