Prognostic significance of surgical extranodal extension in head and neck squamous cell carcinoma patients

Matsumoto, Fumihiko; Mori, Taisuke; Matsumura, Satoko; Matsumoto, Yoshihisa; Fukasawa, Masahiko; Teshima, Masanori; Kobayashi, Kenya; Yoshimoto, Seiichi

doi:10.1093/jjco/hyx055

Cited by 24 publications

(22 citation statements)

References 24 publications

(19 reference statements)

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“…PNI has a well-recognised prognostic role and is associated with dismal prognosis in head and neck tumours 3940 . The presence of ENE also indicates an increased risk of tumour relapse, confirming its role as an independent poor prognostic factor 41 .…”

Section: Discussionmentioning

confidence: 80%

Long-term disease-free survival in surgically-resected oral tongue cancer: a 10-year retrospective study

Marra

Violati

Broggio

et al. 2019

Acta Otorhinolaryngol Ital

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SUMMARY Early and loco-regionally advanced oral tongue squamous cell carcinoma (OTSCC) can be treated by surgery alone or followed by adjuvant radiotherapy or chemoradiotherapy. Nevertheless, up to 40% of patients develop tumour relapse. The aim of our study is to investigate the clinical and pathological features associated with reduced disease-free survival (DFS) in a cohort of surgically-resected OTSCC patients. One hundred and six patients surgically resected for OTSCC were retrospectively identified from clinical records. DFS was calculated according to the Kaplan–Meier method and differences between variables were assessed with Log-Rank test. A multivariable Cox regression model was used to analyse the impact of different prognostic factors on DFS. After a median of follow-up of 8.9 years, 22 events, including 11 deaths, were observed. Overall, the 5-year DFS-rate was 87.4%. The presence of extra-nodal extension (p = 0.023) and perineural invasion (p = 0.003) were significantly correlated with shorter DFS (in univariate analysis). In multivariable analysis, extra-nodal extension and perineural invasion confirmed their role as independent prognostic factors associated with an increased risk of disease recurrence [hazard ratio (HR) 2.87, 95% CI 1.11-7.42, p = 0.03; HR 3.85, 95% CI 1.49-9.96, p = 0.006, respectively]. p16 and p53 expressions in tumour cells were detected in 12% (n = 9) and 46% (n = 40) of cases, respectively. No differences in DFS were observed between p16+ and p16- (p = 0.125) and between p53+ and p53- tumours (p = 0.213). In conclusion, radical surgery, eventually followed by adjuvant radiotherapy or chemo-radiotherapy, can achieve high cure rates in OTSCC. After long-term follow-up, perineural invasion and extra-nodal extension confirmed their role as prognostic factors associated with reduced DFS in OTSCC patients.

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Section: Discussionmentioning

confidence: 80%

Long-term disease-free survival in surgically-resected oral tongue cancer: a 10-year retrospective study

Marra

Violati

Broggio

et al. 2019

Acta Otorhinolaryngol Ital

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“…Patients with breast, prostate, and head and neck cancers tend to develop metastases to superficial lymph nodes (axillary, supraclavicular, and inguinal nodes) and often develop skin involvement [40,43]. In these cancers, extranodal extension is a prognostic factor for survival [60,61,62,63].…”

Section: Possible Mechanisms Of Skin Metastasesmentioning

confidence: 99%

Cutaneous Metastasis after Surgery, Injury, Lymphadenopathy, and Peritonitis: Possible Mechanisms

Otsuka

2019

IJMS

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Cutaneous metastases from internal malignancies are uncommon. Umbilical metastasis, also known as Sister Joseph nodule (SJN), develops in patients with carcinomatous peritonitis or superficial lymphadenopathy, while non-SJN skin metastases develop after surgery, injury, and lymphadenopathy. In this review, the possible mechanisms of skin metastases are discussed. SJNs develop by the contiguous or lymphatic spread of tumor cells. After surgery and injury, tumor cells spread by direct implantation or hematogenous metastasis, and after lymphadenopathy, they spread by extranodal extension. The inflammatory response occurring during wound healing is exploited by tumor cells and facilitates tumor growth. Macrophages are crucial drivers of tumor-promoting inflammation, which is a source of survival, growth and angiogenic factors. Angiogenesis is promoted by the vascular endothelial growth factor (VEGF), which also mediates tumor-associated immunodeficiency. In the subcutaneous tissues that surround metastatic lymph nodes, adipocytes promote tumor growth. In the elderly, age-associated immunosuppression may facilitate hematogenous metastasis. Anti-VEGF therapy affects recurrence patterns but at the same time, may increase the risk of skin metastases. Immune suppression associated with inflammation may play a key role in skin metastasis development. Thus, immune therapies, including immune checkpoint inhibitors reactivating cytotoxic T-cell function and inhibiting tumor-associated macrophage function, appear promising.

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“…This study fails to confirm that finding, likely due to the inherent limitation of its retrospective design. It is interesting to note that the AJCC TNM staging, 8th edition incorporated a separate staging system for cutaneous SCC specific to the head and neck region, and additionally introduced ENE to its N category stratification . ENE is not currently accounted for in the melanoma N category staging.…”

Section: Discussionmentioning

confidence: 99%

“…It is interesting to note that the AJCC TNM staging, 8th edition incorporated a separate staging system for cutaneous SCC specific to the head and neck region, and additionally introduced ENE to its N category stratification. 18…”

Section: Discussionmentioning

confidence: 99%

Surgical management of the neck in patients with metastatic melanoma in parotid lymph nodes

Hondt

Starr

Millett

et al. 2019

Journal of Surgical Oncology

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Background The role and extent of neck dissection in patients with parotid metastatic cutaneous head and neck melanoma remain unclear. The aims of this study were to determine the incidence and patterns of cervical node involvement in patients with parotid metastatic melanoma, and to determine if a limited lymphadenectomy of the clinically negative neck is appropriate. Methods Patients who underwent parotidectomy and neck dissection for clinically apparent parotid metastatic melanoma, irrespective of neck status, were identified from two prospectively maintained databases. Results A total of 276 patients fulfilled the study criteria. Median follow‐up was 23 months. A total of 185 necks were clinically negative, 82 were clinically positive. A total of 36 elective neck‐dissection specimens harbored occult metastases; these were found in levels I (16.7%), II (58.3%), III (36.1%), IV (13.9%), and V (30.6%). Regional recurrence occurred in 32 patients with a clinically negative neck, the majority being in‐transit metastases (n = 15). Only one case of recurrence could have potentially been avoided by a comprehensive lymphadenectomy. Conclusions In patients with clinically apparent parotid melanoma metastases, elective comprehensive neck dissection reduces failure rates in cervical nodes, and provides more accurate staging and prognostic information. However, our findings support the emerging trend for more limited elective neck dissection. Levels I and IV can probably be safely omitted.

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Prognostic significance of surgical extranodal extension in head and neck squamous cell carcinoma patients

Cited by 24 publications

References 24 publications

Long-term disease-free survival in surgically-resected oral tongue cancer: a 10-year retrospective study

Long-term disease-free survival in surgically-resected oral tongue cancer: a 10-year retrospective study

Cutaneous Metastasis after Surgery, Injury, Lymphadenopathy, and Peritonitis: Possible Mechanisms

Surgical management of the neck in patients with metastatic melanoma in parotid lymph nodes

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