Extent of extracapsular spread

Greenberg, Jayson S.; Fowler, Robert L.; Gómez, José A.; Mo, Vivian; Roberts, Dianna B.; Naggar, Adel K. El; Myers, Jeffrey N.

doi:10.1002/cncr.11202

Cited by 213 publications

(54 citation statements)

References 20 publications

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“…Multiple occurrences of ENS-positive 1st mets have been indicated as higher-risk factor in patients with HNSCC compared to a single occurrence of an ENS-positive met [14, 15]. However, the present study did not support this concept.…”

Section: Discussioncontrasting

confidence: 94%

Extranodal spread of primary and secondary metastatic nodes: The dominant risk factor of survival in patients with head and neck squamous cell carcinoma

2017

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Extranodal spread (ENS) in patients with head and neck squamous cell carcinoma (HNSCC) can greatly influence the prognostic outcomes. However, the relative risks of ENS in the primary (1st) and secondary (2nd) metastatic nodes (mets) are not well documented. We retrospectively analyzed the hazard ratios (HRs) of ENS in the 1st and 2nd mets from 516 HNSCC patients who had undergone primary tumor excision. The impact of clinically and/or histologically confirmed ENS-positive mets on prognosis in terms of cancer-specific survival was analyzed. Cox proportional hazard regression analysis indicated that ENS-positive 1st met (adjusted HR = 3.15; 95% CI, 1.40–7.56; p = 0.006) and ENS-positive 2nd met (adjusted HR = 4.03; 95% CI, 1.41–16.96; p = 0.007) significantly and independently predicted poor prognosis; however, other variables including primary site, met size or numbers, and met location in the contralateral side of the primary lesion, did not. Cumulative incidence function and Cox analyses indicated that differences in ENS profiles of 1st and 2nd mets stratified HNSCC patients with varying risks of poor outcome; HRs relative to patients with ENS-positive 1st met (-)/ENS-positive 2nd met (-) were 4.02 (95% CI, 1.78–8.24; p = 0.002), 8.29 (95% CI, 4.58–14.76; p <0.001), and 25.80 (95% CI, 10.15–57.69; p <0.001) for patients with ENS-positive 1st met (+)/ENS-positive 2nd met (-), ENS-positive 1st met (-)/ENS-positive 2nd met (+), and ENS-positive 1st met (+)/ENS-positive 2nd met (+) patients, respectively. Kaplan-Meier analysis indicated that the 2nd met that appeared in the neck side with a history of 1st met and neck dissection had a higher risk of ENS than the 2nd met in the neck side without the history (p = 0.003). These results suggested that ENS is a dominant prognostic predictor of HNSCC patients, with double-positive ENS in the 1st and 2nd mets predicting the most devastating outcome.

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Section: Discussioncontrasting

confidence: 94%

Extranodal spread of primary and secondary metastatic nodes: The dominant risk factor of survival in patients with head and neck squamous cell carcinoma

2017

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“…Because the presence of ECS has been identified as an indicator of poor prognosis, patients with ECS are commonly treated with adjuvant therapy, including radiotherapy and chemoradiotherapy. Yet, despite adjuvant therapy, one-third of patients will experience regional recurrence [25]. …”

Section: Prognostic Indicatorsmentioning

confidence: 99%

Contemporary management of cancer of the oral cavity

Genden

Ferlito²,

Silver

et al. 2010

Eur Arch Otorhinolaryngol

110

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Oral cancer represents a common entity comprising a third of all head and neck malignant tumors. The options for curative treatment of oral cavity cancer have not changed significantly in the last three decades; however, the work up, the approach to surveillance, and the options for reconstruction have evolved significantly. Because of the profound functional and cosmetic importance of the oral cavity, management of oral cavity cancers requires a thorough understanding of disease progression, approaches to management and options for reconstruction. The purpose of this review is to discuss the most current management options for oral cavity cancers.

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“…Greengerg and colleagues showed that pathologic stage N2 was correlated with poor prognosis in patients with tongue cancer, regardless of the status of extracapsular spreading. [4], [5] Several analyses of the treatment of oral cavity cancer have also shown that patients with multiple-node metastases have a higher risk of tumor recurrence. [6]–[9] Therefore, excluding these patients from postoperative CCRT is worrisome.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Concomitant Chemoradiotherapy Improved Treatment Outcomes of Patients with Oral Cavity Cancer with Multiple-Node Metastases but No Other Major Risk Factors

et al. 2014

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PurposeTo investigate the results of postoperative radiotherapy (PORT) for the treatment of pathologic N2b/c squamous cell carcinoma of the oral cavity (OSCC).Materials and MethodsThis study reviewed cancer registry data collected in our hospital from 1998 to 2009 with the following inclusion criteria: primary OSCC, treatment with radical surgery, and multiple nodal metastases. Patients who had extracapsular spreading of the lymph node metastases or positive resection margins or who refused to undergo PORT were excluded. The prescribed dose of PORT was 60–66 Gy. Concurrent chemotherapy was optional. Patient characteristics, treatment parameters and clinical outcome were recorded. The primary end point was overall survival, and the secondary endpoint was disease status.ResultsThere were 138 eligible cases, and the median follow-up period was 35 months. The 3-year overall survival rate was 56%. Univariate analysis revealed that pathologic T4 status (pT4), bone marrow invasion, and lymphatic invasion were significantly correlated with poor outcome (p<0.05). Multivariate analysis showed that pT4, lymphatic invasion, and the no concurrent chemotherapy were independent poor prognostic factors (p<0.05). Fifty-four patients had tumor recurrence. The 3-year recurrence-free survival rate was 59%. Skin invasion, pT4, and bone marrow invasion were correlated with poor prognosis in the univariate analysis (p<0.05). Only pT4 (p<0.01) and no concurrent chemotherapy (p = 0.03) were independently correlated with poor recurrence-free survival.ConclusionFor OSCC patients with multiple-node metastases without extracapsular spreading or positive resection margins, PORT without concurrent chemotherapy correlated to inferior outcome. Multiple lymph node metastases might be considered an indication for concurrent chemotherapy.

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Extent of extracapsular spread

Cited by 213 publications

References 20 publications

Extranodal spread of primary and secondary metastatic nodes: The dominant risk factor of survival in patients with head and neck squamous cell carcinoma

Extranodal spread of primary and secondary metastatic nodes: The dominant risk factor of survival in patients with head and neck squamous cell carcinoma

Contemporary management of cancer of the oral cavity

Postoperative Concomitant Chemoradiotherapy Improved Treatment Outcomes of Patients with Oral Cavity Cancer with Multiple-Node Metastases but No Other Major Risk Factors

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