Prognostic Value of Lymph Node Yield and Density in Head and Neck Malignancies

Abstract

Objective Studies have suggested that the lymph node yield and lymph node density from selective or elective neck dissections are predictive of patient outcomes and may be used for patient counseling, treatment planning, or quality measurement. Our objective was to systematically review the literature and conduct a meta-analysis of studies that investigated the prognostic significance of lymph node yield and/or lymph node density after neck dissection for patients with head and neck cancer. Data Sources The Ovid/Medline, Ovid/Embase, and NLM PubMed databases were systematically searched on January 23, 2017, for articles published between January 1, 1946, and January 23, 2017. Review Methods We reviewed English-language original research that included survival analysis of patients undergoing neck dissection for a head and neck malignancy stratified by lymph node yield and/or lymph node density. Study data were extracted by 2 independent researchers (S.C. and M.O.). We utilized the DerSimonian and Laird random effects model to account for heterogeneity of studies. Results Our search yielded 350 nonduplicate articles, with 23 studies included in the final synthesis. Pooled results demonstrated that increased lymph node yield was associated with a significant improvement in survival (hazard ratio, 0.833; 95% CI, 0.790-0.879). Additionally, we found that increased lymph node density was associated with poorer survival (hazard ratio, 1.916; 95% CI, 1.637-2.241). Conclusions Increased nodal yield portends improved outcomes and may be a valuable quality indicator for neck dissections, while increased lymph node density is associated with diminished survival and may be used for postsurgical counseling and planning for adjuvant therapy.

HPV status in unknown primary head and neck cancer: Prognosis and treatment outcomes

“…We addressed this issue by including patients undergoing a combined treatment modality only if the timing of their treatments was consistent with that of chemoradiotherapy, adjuvant radiotherapy, or adjuvant chemoradiotherapy. Additionally, due to missing data, we were unable to control for surgical quality control variables such as nodal yield, which have been shown to be prognostic indicators for cancers of the head and neck . Lack of morbidity data also limited our ability to detect treatment‐associated morbidities.…”

“…Additionally, due to missing data, we were unable to control for surgical quality control variables such as nodal yield, which have been shown to be prognostic indicators for cancers of the head and neck. 60 Lack of morbidity data also limited our ability to detect treatment-associated morbidities. Finally, we did not have data on local control or disease-specific survival and could not determine how the utilized treatment modality affected disease recurrence rates.…”

Changing prognosis of oral cancer: An analysis of survival and treatment between 1973 and 2014

“…Given recent data supporting the prognostic significance of nodal yield in head and neck malignancies, this is a notable change in practice. 17,[34][35][36] In this study, we found that from 1981 to 2010, there was a significant association between African American race and decreased survival. This was previously reported by Funk et al, who found significantly lower 5-year relative survival rates in African Americans than other racial groups at all disease stages.…”

“…Neck dissection nodal yields have also consistently increased for neck dissections performed on both early‐ and late‐stage patients. Given recent data supporting the prognostic significance of nodal yield in head and neck malignancies, this is a notable change in practice …”

Adjuvant Chemotherapy Is Associated With Improved Survival for Late‐Stage Salivary Squamous Cell Carcinoma

“…We were also unable to stratify or control based on several NCCN guideline features, such as perineural invasion, lymphatic/vascular invasion, and nodal location, which were not available in the data source. Additionally, due to a lack of data, we were unable to control for nodal yields in patients who underwent neck dissection, which has been shown to be prognostic of survival in other head and neck malignancies . Although we found a survival benefit for chemoradiotherapy in late‐stage squamous cell salivary malignancy, the small size of the early‐stage patients treated with chemoradiotherapy limited the conclusions that we could draw about this group.…”