Nodal yield and survival in oral squamous cancer

Abstract

BACKGROUND: Elective neck dissection (END) is commonly used as a staging and therapeutic procedure for oral squamous cell carcinoma (SCC) at high risk of nodal metastases. The authors aimed to determine whether the extent of lymphadenectomy, as defined by nodal yield, is a prognostic factor in this setting. METHODS: A retrospective database review identified 225 patients undergoing END with curative intent for oral SCC between 1987 and 2009. Nodal yield was studied as a categorical variable for association with overall, disease-specific, and disease-free survival in univariate and multivariate analyses. RESULTS: Nodal yield <18 was associated with 5-year overall survival of 51% compared with 74% in those with nodal yield 18 (P ¼ .009). Five-year disease-specific survival rates were 69% in those with <18 nodes and 87% in patients with 18 nodes (P ¼ .022). Similar results were obtained for disease-free survival, with 5-year rates of 44% with <18 nodes versus 71% with 18 nodes (P ¼ .043). After adjusting for the effect of age, nodal status, T stage, and adjuvant radiotherapy on multivariate analysis, nodal yield <18 was associated with reduced overall (hazard ratio [HR], 2.0; 95% confidence interval [CI], 1.1-3.6; P ¼ .020), disease-specific (HR, 2.2; 95% CI, 1.1-4.5; P ¼ .043), and disease-free survival (HR, 1.7; 95% CI, 1.1-2.8; P ¼ .040). In the pathologically lymph nodenegative subgroup (n ¼ 148), similar results were obtained. CONCLUSIONS: Nodal yield is an independent prognostic factor in patients undergoing END for oral SCC. These results suggest that an adequate lymphadenectomy in this setting should include at least 18 nodes.

State-of-the-Art and Emerging Treatment Options in the Management of Head and Neck Cancer: News from 2013

“…On the one hand, selective ND is feasible and safe, but on the other hand the number of excised nodes may impact on survival. Ebrahimi et al [55] reported that nodal yield is an independent prognostic factor in patients undergoing ND. In their retrospective analyses on 225 patients, nodal yield <18 was associated with a 5-year OS of 51% compared with 74% in those with nodal yield >18 (p = 0.009).…”

The Role of Neck Dissection after Radical Chemoradiation for Locally Advanced Head and Neck Cancer: Should We Move Back?

“…The debate on the usefulness of ND leads to a model to predict how many nodes are needed to prevent one fatal neck recurrence after CRT for HNC. As in the results of a study conducted by Javidnia et al [46], it was hypothesized that it is necessary to treat 7.5 patients to prevent one fatal neck recurrence after CRT for HNC with N2–3 disease. In the 2009 update of guidelines on behalf of the American Head and Neck Society, clinicians were encouraged to perform selective ND.…”

“…On the one hand is the risk of neck recurrences or microscopic residual disease, on the other hand is the probability of an overtreatment with possible surgical complications (lymphedema, dysphagia, fistulae) [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72]. Benefits may include local regional control and OS [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,…”

Significado prognóstico do número de linfonodos no esvaziamento cervical eletivo no câncer de língua e soalho de boca

“…There is a recent report that the number of lymph nodes found in the neck dissection is a prognostic factor of mouth cancer 2 . Patients with less than 18 lymph the nine cases of patients who developed isolated regional recurrences, all had 20 or more lymphnodes upon neck dissection.…”