Prognostic Significance of Extranodal Extension in Head and Neck Squamous Cell Carcinoma cN0 Patients With Occult Metastatic Neck Nodes

Lop, Joan; Rigó, Antoni; Codina, A; Juan, Julia de; Quer, Miquel; León, Xavier

doi:10.1016/j.otoeng.2017.07.002

Cited by 12 publications

(16 citation statements)

References 32 publications

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“…The lack of reliable predictors for occult metastasis contributes to the discussion. Although perineural invasion (PNI), lymphovascular invasion (LVI), depth of invasion (DOI), extranodal extension (ENE), and lingual lymph node metastasis have been shown to increase the rate of occult metastasis (1,9,10), these variables are always unknown prior to the availability of definite postoperative pathology, and their clinical application is greatly limited.…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of Occult Metastasis and Survival Significance of Metabolic Tumor Volume Determined by PET-CT in cT1-2N0 Squamous Cell Carcinoma of the Tongue

Yang

Liu

et al. 2020

Front. Oncol.

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ObjectivesOur goal was to analyze the possibility of using metabolic tumor volume (MTV) to predict occult cervical metastasis and survival in cT1-2N0 squamous cell carcinoma (SCC) of the tongue.MethodsData on the primary tumor MTV and cervical node status as determined by the maximum standardized uptake value were retrieved. The sensitivity and specificity in predicting occult metastasis were calculated with a fourfold table. Associations between occult metastasis and clinicopathological variables were evaluated by univariate and multivariate analyses. The main study endpoints were locoregional control (LRC) and disease-specific survival (DSS).ResultsA total of 24 (20.3%) of 118 patients had occult metastasis. An MTV cutoff value of 4.3 cm3 showed a sensitivity of 50.0% and a specificity of 76.6% in predicting occult metastasis. The sensitivity and specificity of PET-CT in predicting occult metastasis in cT1 tumors were 66.6 and 89.8%, respectively, with values of 83.3 and 67.3%, respectively, when combined with the MTV. The sensitivity and specificity of PET-CT in predicting occult metastasis in cT2 tumors were 72.2 and 82.2%, respectively, with values of 88.9 and 57.8%, respectively, when combined with the MTV. Patients with MTV ≥4.3 cm3 had a higher occult metastasis rate than patients with MTV <4.3 cm3. The 5-year LRC and DSS rates were 86 and 94%, respectively, in patients with MTV <4.3 cm3 and 54 and 72%, respectively, in patients with MTV ≥4.3 cm3. Both differences were found to be significant in univariate and multivariate analyses.ConclusionsMTV ≥4.3 cm3 was associated with an increased probability of occult metastasis and lower LRC and DSS rates in early-stage SCC of the tongue.

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Section: Introductionmentioning

confidence: 99%

Predictive Value of Occult Metastasis and Survival Significance of Metabolic Tumor Volume Determined by PET-CT in cT1-2N0 Squamous Cell Carcinoma of the Tongue

Yang

Liu

et al. 2020

Front. Oncol.

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“…A total of 284 hits were screened and 261 of these were excluded as being irrelevant. Of the 23 studies that were relevant, three studies [15][16][17] were excluded because they included different subsites of head and neck cancer. Therefore, 20 studies were eligible as they evaluated the prognostic performance of AJCC 8 in OSCC (Figure 1).…”

Section: Search Resultsmentioning

confidence: 99%

“…In patients with OSCC, as well as in those with other cancers of head and neck, extranodal extension is a common microscopic feature and it was widely reported as a promising prognostic factor to identify cases at high-risk of worse prognosis. 16,48 The impact of including extranodal extension into the N classification of AJCC 8 has been analyzed in many studies (Table 1). Our meta-analysis showed an incremental increase in risk of worse survival with each higher N classification of AJCC 8 ( Figure S2).…”

Section: Discussionmentioning

confidence: 99%

“…We also noted that studies examining the significance of AJCC 8 in cohorts of mucosal squamous cell carcinoma from different subsites of the head and neck, including the oral cavity, have shown a good prognostic performance of AJCC 8. [15][16][17] Even though some authors have criticized the complexity of AJCC 8 due to the inclusion of depth of invasion and extranodal extension, they have, however, also reported a useful performance of AJCC 8. 26 The published studies have cohorts from different geographic regions (Asia, Australia, Europe, North America, and South America) with different ethnic groups and with variable socioeconomic status.…”

Section: Discussionmentioning

confidence: 99%

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Risk stratification in oral squamous cell carcinoma using staging of the eighth American Joint Committee on Cancer: Systematic review and meta‐analysis

et al. 2020

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The eighth edition of the American Joint Committee on Cancer (AJCC8) staging manual has major changes in oral squamous cell carcinoma (OSCC). We searched PubMed, OvidMedline, Scopus, and Web of Science for studies that examined the performance of AJCC8 in OSCC. A total of 40 808 patients were included in the studies of our meta‐analysis. A hazard ratio (HR) of 1.87 (95%CI 1.78‐1.96) was seen for stage II, 2.65 (95%CI 2.51‐2.80) for stage III, 3.46 (95%CI 3.31‐3.61) for stage IVa, and 7.09 (95%CI 4.85‐10.36) for stage IVb. A similar gradual increase in risk was noted for the N classification. For the T classification, however, there was a less clear variation in risk between T3 and T4. AJCC8 provides a good risk stratification for OSCC. Future research should examine the proposals introduced in the published studies to further improve the performance of AJCC8.

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“…In this background, we read the research article pertaining to elective neck dissection (END) in the clinically node-negative neck there is no mention of the extent or type of neck dissection and the nodal yield in the cohort, the number of positive nodes in the node-positive neck or whether there was any extranodal metastasis present. 5 Again, each of these may have an influence on the survival.…”

Section: E T T E R T O T H E E D I T O Rmentioning

confidence: 99%

Elective neck dissection (END) and cN0 hard palate and upper gingival cancers: A National Cancer Database analysis of factors predictive of END and impact on survival—How much is the impact?

Gill

Jain

Thiagarajan

2020

Journal of Surgical Oncology

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The risks of nodal metastasis from upper alveolus and hard palate are not well defined. Traditionally they are believed to be at low risk for nodal metastasis, and clinically a node-negative neck is usually observed. In this background, we read the research article pertaining to elective neck dissection (END) in the clinically node-negative neck (cN0) hard palate and upper gingival cancers by Obayemi et al 1 with great interest, and we would like to congratulate the authors for their effort. This article has demonstrated an overall survival benefit of END for cN0 patients of the mucosal maxilla (gingiva and hard palate).Though the authors have mentioned certain limitations of their study themselves in the article, we would like to put forth our observations pertaining to this study that need to be kept in mind while interpreting the results.Previously, a systematic review by Tang et al 2 on the same question also showed an improvement in survival with END. They included 10 (retrospective) studies reported between 2006 and 2014. A total of 506 patients were included in the study overall, out of this 206 patients underwent END and 300 were observed. The 5-year survival reported in this article was 80.3% in those who underwent END and 67.4% in those who were observed. Incidence of Occult metastasis as per the pT-category was 11.1%, 12.1%, 20%, and 36.1% for pT1, pT2, pT3, and pT4, respectively. The authors concluded that END could be justified in T3 and T4 tumors of the upper gingiva and alveolus with a cN0 neck. Though Obayemi et al, 1 have shown an improvement in survival with END, even for T1 primary tumor, there was no mention of the certain histopathological adverse features such as lymphovascular embolis, perineural invasion, and positive surgical margins, each of which could have an impact on the prognosis themselves. 3,4 Also there is no mention of the extent or type of neck dissection and the nodal yield in the cohort, the number of positive nodes in the node-positive neck or whether there was any extranodal metastasis present. 5 Again, each of these may have an influence on the survival.Details of the adjuvant treatment given, in terms of radiotherapy (RT) alone or the addition of chemotherapy to RT were also not available.It is important to know this information, as the adjuvant treatments could directly have an impact on the survival over and above the neck dissection. 4The details regarding the type of recurrences in the END and the observation arms (local/regional/distant metastasis/combination of these) was not given. These details could provide more insight on the recurrence patterns in the two arms and whether the recurrences were salvageable by additional locoregional therapy. This information could have added more importance to the need to initially do END in these patients. Although salvage surgery could be performed for some of the recurrences, it is important to remember that the outcomes of salvage surgery have been traditionally poor. 6 Morris et al 6 reported that although salvage surgery ca...

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Prognostic Significance of Extranodal Extension in Head and Neck Squamous Cell Carcinoma cN0 Patients With Occult Metastatic Neck Nodes

Cited by 12 publications

References 32 publications

Predictive Value of Occult Metastasis and Survival Significance of Metabolic Tumor Volume Determined by PET-CT in cT1-2N0 Squamous Cell Carcinoma of the Tongue

Predictive Value of Occult Metastasis and Survival Significance of Metabolic Tumor Volume Determined by PET-CT in cT1-2N0 Squamous Cell Carcinoma of the Tongue

Risk stratification in oral squamous cell carcinoma using staging of the eighth American Joint Committee on Cancer: Systematic review and meta‐analysis

Elective neck dissection (END) and cN0 hard palate and upper gingival cancers: A National Cancer Database analysis of factors predictive of END and impact on survival—How much is the impact?

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