Background Prospective quality metrics for neck dissection have not been established for patients with head and neck squamous cell carcinoma. The purpose of this study is to investigate the association between lymph node counts from neck dissection, local-regional recurrence, and overall survival. Methods The number of lymph nodes counted from neck dissection in patients treated on NRG Oncology RTOG trials 9501 and 0234 was evaluated for its prognostic impact on overall survival using a multivariate Cox model adjusted for demographic, tumor, and lymph node data, and stratified by postoperative treatment group. Results 572 patients were analyzed at median follow-up of eight years. 98% of patients were pathologically N+. Median number of lymph nodes recorded on the left and right sides were 24 and 25. Fewer than 18 nodes identified was associated with worse overall survival relative to ≥18 nodes (hazard ratio 1.38, 95%CI 1.09–1.74, p=0.007). The difference appeared to be driven by local-regional failure (HR 1.46, 95%CI 1.02–2.08, p=0.04) but not distant metastases (HR 1.08, 95%CI 0.77–1.53, p=0.65). When analysis was limited to NRG Oncology RTOG 0234 patients, adding p16 status to the model did not affect the hazard ratio for dissected nodes and the effect of nodes was not different by p16 status. Conclusion The removal and identification of 18 or more lymph nodes was associated with improved overall survival and lower rates of local-regional failure, and should be further evaluated as a measure of quality in neck dissections for mucosal squamous cell carcinoma.

In recent years, the general profile of patients with AK has changed at WEH. Currently, we are treating older patients with more severe keratitis who are presenting later and with worse vision compared with our previous patients. At the same time, treatment outcomes have been poorer.

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