Analysis of risk factors for retropharyngeal lymph node metastasis in carcinoma of the hypopharynx

Zheng, Wei; Deng, Xue-Ying; Zeng, Ruolan; Su, Yong; Gu, Mo-Fa; Zhang, Yun; Xie, Congying; Zheng, Lie

doi:10.1002/hed.23112

Cited by 20 publications

(28 citation statements)

References 20 publications

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“…These findings suggest that bilateral RPLN dissection should be considered in the locally advanced HPC extending to the contralateral side. In accordance with previous report, 16 RPLN metastasis was the most common in 25 of posterior cancer, but was also observed in 20% of postcricoid cancer and 11.3% of pyriform sinus cancer. By statistical analysis using chi-square test, presence of 3 or more pathological metastatic LN, level II pathological LN metastasis and bilateral pathological LN metastasis were significantly correlated with RPLN metastasis.…”

Section: Discussionsupporting

confidence: 92%

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Impact of retropharyngeal lymph node dissection in the surgical treatment of hypopharyngeal cancer

et al. 2019

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Objectives To evaluate the impact of retropharyngeal lymph node (RPLN) dissection in the surgical treatment of hypopharyngeal cancer. Methods Between 2007 and 2016, 98 previously untreated patients with pathological diagnosed hypopharyngeal squamous cell carcinoma underwent total pharyngolaryngectomy and bilateral neck dissection at Kobe University Hospital. Bilateral dissection of RPLN was simultaneously performed in all patients. Pharynx was reconstructed with free jejunal transfer in 94 patients and primarily closed in 4 patients. Postoperative chemoradiotherapy was performed in patients with high risk factors including metastasis to RPLN, multiple lymph node metastasis, extranodal invasion, and/or positive/close surgical margins. Results The median follow‐up period was 25 months ranging from 1 to 105 months. RPLN adenopathy was preoperatively identified in 9 patients in FDG‐positron emission tomography. All of them had pathologically diagnosed RPLN metastases, which had been controlled in all patients during the observation periods. Among the other 89 patients, 7 patients had RPLN metastasis. The 2‐year overall survival rates of the patients with and without RPLN metastasis were 65.7% and 69.8% (P = .61), respectively. Conclusions In the present study, patients with RPLN metastasis showed equally favorable oncological outcome compared with patients without RPLN metastasis. At least, ipsilateral RPLN dissection should be considered in the surgical treatment of advanced hypopharyngeal cancer and multiple neck lymph node metastasis regardless of primary subsite.

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Section: Discussionsupporting

confidence: 92%

“…Involvement of RPLN is relatively rare in HPC patients, but could result in a cause of death . Reported rates of RPLN metastasis ranged from 14% to 19%, in accordance with our study (16.3%). As previously reported, preoperative FDG‐PET/CT scan was useful to evaluate RPLN in our study.…”

Section: Discussionsupporting

confidence: 91%

Impact of retropharyngeal lymph node dissection in the surgical treatment of hypopharyngeal cancer

et al. 2019

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“…Furthermore, three patients (50.0%) occured nodal failure at level II in contralateral or bilateral necks for patients not receiving adjuvant radiation therapy, which was much higher than patients who recevive postoperative RT (50.0% vs. 2.5%, P < 0.001; OR = 0.026, 95%CI: 0.002-0.328). Based on results found in our study, irradiation of the level VIb and VII should be recommended, especially for the primary tumors originated from posterior pharyngeal wall (PPW), PPW invasion, postcricoid invasion, and esophagus invasion [22,23].…”

Section: Discussionmentioning

confidence: 84%

Patterns of regional lymph node failure of locally advanced hypopharyngeal squamous cell carcinoma after first-line treatment with surgery and/or intensity-modulated radiotherapy

Wang

Zhai

et al. 2020

BMC Cancer

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Background: To identify the spatial patterns of regional lymph node failure of locally advanced hypopharyngeal squamous cell carcinoma (SCC) after first-line treatment with surgery and/or intensity-modulated radiotherapy (IMRT). Methods: We retrospectively obtained the clinicopathological characters of 123 hypopharyngeal SCC patients, and investigated the patterns of regional lymph node failure. Univariate and multivariate logistic regression were used to determine the risk factors of regional lymph node failure. Results: Forty patients (32.5% of total patients) were suffered regional lymph node failure. In these patients, the ipsilateral neck level II nodal failure account for 55.0% (22/40) followed by level III 30.0% (12/40), level VIb 15.0% (6/ 40), level VII 15.0% (6/40), and level IV 5.0% (2/40). In addition, 17.5% (7/40) patients suffered contralateral neck level II nodal failure and 7.5% (3/40) patients suffered level III nodal failure. The common failure levels were the II (7/46, 15.2%), III (4/46, 8.7%), VIb (4/46, 8.7%), and VII (5/46, 10.9%) for treatment by surgery. The lymph node recurrence and persistent disease at levels II (19/77, 24.7%) and III (10/77, 13.0%) remained the major cause of failure following curative intent of IMRT. The postoperative radiation significantly decreased the risk of regional lymph node failure (OR = 0.082, 95% CI: 0.007-1.000, P = 0.049); and the radiologic extranodal extension significantly increased the risk of regional lymph node failure (OR = 11.07, 95% CI: 2.870-42.69, P < 0.001). Conclusions: Whatever the treatment modality, the lymph node failure at level II and III was the most popular pattern for hypopharyngeal SCC. Moreover, for patients who underwent surgery, the nodal failure at level VIb and VII was frequent. Thus, postoperative radiation of level VIb and VII may give rise to benefit to locally advanced hypopharyngeal SCC patients.

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“…Previous studies had indicated the incidence of RPLN of HPC was 20–62%. Su et al 10 found out the incidence of RPLN metastasis in HPC from 218 patients was 17.0%, and the highest rate of 36.4% was found in posterior pharyngeal wall tumor, mainly based on CT. Our study had a higher rate of RPLN metastasis (21.5%) and primary tumor located in posterior pharyngeal wall (53.1%).…”

Section: Discussionmentioning

confidence: 99%

“…There were a few studies in the early years showed that the risk factor of RPLN may be related to T stage, N stage, or the numbers of nodes. 12 , 15 Su et al 10 demonstrated that the primary tumor subsites, bilateral cervical LN metastasis, the number and size of cervical LNs, and level V metastasis were significantly associated with RPLN metastasis. The incidence of RPLN is higher in patients with LN metastasis in other cervical regions.…”

Section: Discussionmentioning

confidence: 99%

<p>The Pattern of Cervical Lymph Node Metastasis and Risk Factors of Retropharyngeal Lymph Node Metastasis Based on Magnetic Resonance Imaging in Different Sites of Hypopharyngeal Carcinoma</p>

Wang

Huang

et al. 2020

CMAR

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Background This study was to determine the patterns of regional lymph node (LN) spread and the risk factors of retropharyngeal lymph node (RPLN) metastasis based on magnetic resonance imaging (MRI) in hypopharyngeal squamous carcinoma (HPC) to improve clinical target volume (CTV) delineation. Methods A cohort of 326 consecutive patients of HPC in a single institute were retrospectively reviewed. All patients underwent MRI prior to initial treatment, and the diagnosis based on MRI of the LN metastasis was confirmed by all radiation oncologists in the head and neck group during twice weekly chat rounds. Statistical analysis of data was using chi-square test and multivariant logistic regression model in SPSS 22.0 software. Results The LN metastasis rate of all patients in this cohort was 90.5% (295/326). Level IIa/b and level III were the most frequently involved regions followed by level IV and retropharyngeal region. Skip metastasis only occurred in 6.4% (19/295). Univariate and multivariate analysis demonstrated that primary tumor subsites were located in the posterior pharyngeal wall ( P =0.002), bilateral cervical LN metastasis ( P =0.020), larger volume of primary gross target (GTVp, P =0.003), and larger volume of LN gross target (GTVnd, P =0.023) were significantly associated with RPLN metastasis. Conclusion The regional LN spread of HPC follows an ordered pattern as level II is the most frequently involved area followed by level III, level IV, and RPLN. RPLN metastasis is more likely to occur in patients with primary site of posterior pharyngeal wall, large tumor burden, or bilateral neck LN metastasis. Therefore, it is highly recommended that the RPLN should be included into CTV for patients who have these risk factors.

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Analysis of risk factors for retropharyngeal lymph node metastasis in carcinoma of the hypopharynx

Abstract: Our findings demonstrated that primary carcinoma subsites and multiple metastatic cervical lymph nodes are the principal risk factors for RPLN metastasis.

Cited by 20 publications

References 20 publications

Impact of retropharyngeal lymph node dissection in the surgical treatment of hypopharyngeal cancer

Impact of retropharyngeal lymph node dissection in the surgical treatment of hypopharyngeal cancer

Patterns of regional lymph node failure of locally advanced hypopharyngeal squamous cell carcinoma after first-line treatment with surgery and/or intensity-modulated radiotherapy

<p>The Pattern of Cervical Lymph Node Metastasis and Risk Factors of Retropharyngeal Lymph Node Metastasis Based on Magnetic Resonance Imaging in Different Sites of Hypopharyngeal Carcinoma</p>

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