Occult Metastasis in Laryngeal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

Sharbel, Daniel D.; Abkemeier, Mary; Groves, Michael W.; Albergotti, William Greer; Byrd, J. Kenneth; Reyes-Gelves, Camilo

doi:10.1177/0003489420937744

Cited by 19 publications

(11 citation statements)

References 48 publications

(99 reference statements)

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“…Another interesting finding in our study was that the T stage had no influence on both the OS and CSS of patients. We believe this is because the head and neck squamous cell carcinoma is characterized by a higher rate of lymph node metastasis; therefore, the degree of tumor invasion may have little impact on the prognosis of the disease [28][29][30]. Surprisingly, we found that marital status plays an important role in the disease prognosis, with married patients having higher cancer survival rates than unmarried patients [31].…”

Section: Discussionmentioning

confidence: 72%

Number of Positive Lymph Nodes Combined with the Logarithmic Ratio of Positive Lymph Nodes predicts Survival in Patients with Non-Metastatic Larynx Squamous Cell Carcinoma

Wang¹,

Tan²,

Zheng³

et al. 2022

J. Cancer

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Background: Logarithmic ratio of positive lymph nodes (LODDS), number of positive lymph nodes (NPLN), and number of lymph nodes to positive lymph nodes (pLNR) are three lymph node classifications; however, their function in prognosis is unclear. Purpose: To establish and validate an optimal nomogram according to the comparison among the 7 th TNM stage of American Joint Committee on Cancer (AJCC) and the three lymph node classifications. Methods: A total of 881 patients from the Surveillance, Epidemiology and End Result (SEER database) with T1-4N1-3M0 in laryngeal squamous cell carcinoma from 2000 to 2018 were involved. The enrolled patients were allocated randomly into a training cohort and a validation cohort. Univariate cox regression analysis and multivariable cox regression analysis were applied to explore the predictors. The Akaike Information Criterion (AIC) and Harrell's concordance index (C-index) were to measure the predictive value and the accuracy of the prognostic models. Moreover, integrated discrimination improvement (IDI) and net reclassification index (NRI) were also used to assess the predictive abilities to models. According to the optimal model, nomograms were established and compared with 7 th TNM stage of AJCC via the decision curve analysis. Results: NPLN, LODDS, and pLNR were three predictors for the overall and cancer-specific survival in the larynx squamous cell carcinoma. According to the AIC, C-index, IDI, and NRI, the model of NPLN combined with LODDS was assumed as the optimal prognostic model. Moreover, the decision curve analysis suggested that the nomogram demonstrated a better predictive performance, compared with the 7 th AJCC TNM stage. Conclusion:The proposed nomograms we constructed for larynx squamous cell carcinoma has potential in the prediction of patients after surgery.

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Section: Discussionmentioning

confidence: 72%

Number of Positive Lymph Nodes Combined with the Logarithmic Ratio of Positive Lymph Nodes predicts Survival in Patients with Non-Metastatic Larynx Squamous Cell Carcinoma

Wang¹,

Tan²,

Zheng³

et al. 2022

J. Cancer

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“…As regional lymph node metastases have a high influence on treatment and prognosis, a decision on the treatment of the neck always needs to be considered. In HNSCC, there is a high risk of occult CLN metastasis in clinically nodal negative necks with incidences of 30% in oropharyngeal [ 19 ], 23.7% in hypopharyngeal [ 20 ] and 20.5% in laryngeal squamous cell carcinoma (SCC) [ 21 ]. It is not always an easy decision in patients with a clinically nodal negative neck between overtreatment in terms of a complete or even a contralateral neck dissection with risks such as bleeding or intraoperative nerve damage and missing occult metastasis [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Quantitative Multiparametric Ultrasound (mpUS) in the Assessment of Inconclusive Cervical Lymph Nodes

Lerchbaumer

Wakonig

Arens

et al. 2022

Cancers

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Background: Enlarged cervical lymph nodes (CLN) are preferably examined by ultrasound (US) by using criteria such as size and echogenicity to assess benign and suspicious CLN, which should be histologically evaluated. This study aims to assess the differentiation of malign and benign CLN by using multiparametric US applications (mpUS). Methods: 101 patients received a standardized US protocol prior to surgical intervention using B-mode–US, shear-wave elastography (SWE) and contrast-enhanced ultrasound (CEUS). SWE was assessed by 2D real-time SWE conducting a minimum of five measurements, CEUS parameters were assessed with post-processing perfusion software. Histopathological confirmation served as the gold standard. Results: B-mode–US and SWE analysis of 104 CLN (36 benign, 68 malignant) showed a significant difference between benign and malignant lesions, presenting a larger long axis and higher tissue stiffness (both p < 0.001). Moreover, tissue stiffness assessed by SWE was significantly higher in CLN with regular B-mode–US criteria (Solbiati Index > 2 and short-axis < 1 cm, p < 0.001). No perfusion parameter on CEUS showed a significant differentiation between benign and malignant CLN. Discussion: As the only multiparametric parameter, SWE showed higher tissue stiffness in malignant CLN, also in subgroups with regular B-mode criteria. This fast and easy application may be a promising noninvasive tool to US examination to ameliorate the sonographic differentiation of inconclusive CLN.

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“…Lymph node metastases (LNMs) are common at the time of diagnosis in head and neck squamous cell carcinomas (HNSCCs), while the rate of occult LNMs is up to 20% in some subtypes of HNSCC [ 1 , 2 , 3 , 4 , 5 ]. The presence of LNMs bears a major prognostic influence, with an estimated 50% reduction in overall survival in nodal negative vs. nodal positive HPV-negative HNSCC [ 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Lymph Node Yield and Ratio in Selective and Modified Radical Neck Dissection in Head and Neck Cancer—Impact on Oncological Outcome

Sheppard

Frech

Giger

et al. 2021

Cancers

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Background: Lymph node metastases are associated with poor prognosis in head and neck squamous cell carcinoma (HNSCC). Neck dissection (ND) is often performed prior to or after (chemo)radiation (CRT) and is an integral part of HNSCC treatment strategies. The impact of CRT delivered prior to ND on lymph node yield (LNY) and lymph node ratio (LNR) has not been comprehensively investigated. Material and methods: A retrospective cohort study was conducted from January 2014 to 30 June 2019 at the University Hospital of Bern, Switzerland. We included 252 patients with primary HNSCC who underwent NDs either before or after CRT. LNY and LNR were compared in patients undergoing ND prior to or after CRT. A total of 137 and 115 patients underwent modified radical ND (levels I to V) and selective ND, respectively. The impact of several features on survival and disease control was assessed. Results: Of the included patients, 170 were male and 82 were females. There were 141 primaries from the oral cavity, 55 from the oropharynx, and 28 from the larynx. ND specimens showed a pN0 stage in 105 patients and pN+ in 147. LNY, but LNR was not significantly higher in patients undergoing upfront ND than in those after CRT (median: 38 vs. 22, p < 0.0001). Cox hazard ratio regression showed that an LNR ≥ 6.5% correlated with poor overall (HR 2.42, CI 1.12-4.89, p = 0.014) and disease-free survival (HR 3.416, CI 1.54-754, p = 0.003) in MRND. Conclusion: ND after CRT leads to significantly reduced LNY. An LNR ≥6.5% is an independent risk factor for decreased overall, disease-free, and distant metastasis-free survival for MRND.

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Occult Metastasis in Laryngeal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

Cited by 19 publications

References 48 publications

Number of Positive Lymph Nodes Combined with the Logarithmic Ratio of Positive Lymph Nodes predicts Survival in Patients with Non-Metastatic Larynx Squamous Cell Carcinoma

Number of Positive Lymph Nodes Combined with the Logarithmic Ratio of Positive Lymph Nodes predicts Survival in Patients with Non-Metastatic Larynx Squamous Cell Carcinoma

Quantitative Multiparametric Ultrasound (mpUS) in the Assessment of Inconclusive Cervical Lymph Nodes

Lymph Node Yield and Ratio in Selective and Modified Radical Neck Dissection in Head and Neck Cancer—Impact on Oncological Outcome

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