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Kim H, Oh T, Cha IH, Kim HJ, Nam W, Kim D. Robot-assisted versus conventional neck dissection: a propensity score matched case-control study on perioperative and oncologic outcomes. J Robot Surg 2024; 18:323. [PMID: 39153111 DOI: 10.1007/s11701-024-02079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/10/2024] [Indexed: 08/19/2024]
Abstract
The widespread acceptance of robotic surgery is extending to oral procedures. The demand for minimally invasive techniques is driving research into the cosmetic and oncologic benefits of robotic neck surgery. This study used propensity score matching to analyze the clinical course and postoperative outcomes of robot-assisted neck dissections for oncologic efficacy and surgical safety. Between May 2020 and April 2024, 200 OSCC patients underwent surgery and 42 were excluded. The cohort included 158 patients, 128 of whom underwent unilateral neck dissection and 30 of whom underwent bilateral neck dissection. Robotic-assisted neck dissection (RAND) was performed in 36 patients while conventional transcervical neck dissection (CTND) was performed in 122 patients. Data analysis included several factors, including lymph node retrieval and perioperative outcomes, with 1:1 propensity score matching to ensure fairness. Each of the 39 neck specimens with 36 patients was selected. The CTND group was 8 years older overall than the RAND group, but otherwise similar in terms of primary site and clinical stage. The RAND group had a 55-min longer operative time and 140 cc more hemovac drainage than the CTND group, but the hospital stay and intensive care unit duration were the same, and the number of lymph nodes retrieved was the same. Survival rates also showed no difference across all stages. This shows that RAND is in no way inferior to CTND in terms of perioperative or oncologic outcomes, and demonstrates the safety of robot-assisted surgery, even in patients who require flaps or in patients with advanced stages.
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Affiliation(s)
- Hyounmin Kim
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Taegyeong Oh
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - In-Ho Cha
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyung Jun Kim
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Woong Nam
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Dongwook Kim
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Oral Science Research Center, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Khalil C, Khoury M, Higgins K, Enepekides D, Karam I, Husain ZA, Bayley A, Poon I, Truong T, Chan KKW, Smoragiewicz M, Fu R, Eskander A. Lymph node yield: Impact on oncologic outcomes in oral cavity cancer. Head Neck 2024; 46:1965-1974. [PMID: 38344842 DOI: 10.1002/hed.27656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Lymph node metastases are associated with poor prognosis in oral cavity squamous cell carcinoma (OCSCC). In other cancers, clinical guidelines on the number of lymph nodes removed during primary surgery, lymph node yield (LNY), exist. Here, we evaluated the prognostic capacity of LNY on regional failure, locoregional recurrence, and disease-free survival (DFS) in patients with OCSCC treated by primary neck surgery. METHODS This retrospective cohort study took place at Sunnybrook Health Sciences Centre in Toronto, Canada and involved a chart review of all adult patients with treatment-naive OCSCC undergoing primary neck dissection. For each outcome, we first used the maximally selected rank statistics and an optimism-corrected concordance to identify an optimal threshold of LNY. We then used a multivariable Cox proportional hazards model to assess the association between high LNY (>threshold) and each outcome. RESULTS Among the 579 patients with OCSCC receiving primary neck dissection, 61.7% (n = 357) were male with a mean age of 62.9 years (standard deviation: 13.1) at cancer diagnosis. When adjusting for sociodemographic and clinical factors, LNY >15 was significantly associated with improved DFS (adjusted HR [aHR]: 0.73, 95% CI: 0.54-0.98), locoregional recurrence (aHR: 0.68, 95% CI: 0.49-0.95), and regional failure (aHR: 0.61, 95% CI: 0.39-0.93). CONCLUSIONS Our study findings suggested high LNY to be a strong independent predictor of various patient-level quality of surgical care metrics. The optimal LNY we found (15) was lower than the conventionally recommended (18), which calls for further research to establish validity in practice.
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Affiliation(s)
- Carlos Khalil
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mark Khoury
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Zain Ali Husain
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Andrew Bayley
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ian Poon
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Tra Truong
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Martin Smoragiewicz
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rui Fu
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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3
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Hanberg P, Tramm T, Pikelis A, Schytte S, Gade SD, Klug TE. Factors affecting lymph node yield and density in neck dissection. Acta Otolaryngol 2024:1-5. [PMID: 39041248 DOI: 10.1080/00016489.2024.2380863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Studies suggest that neck dissections with a minimum of 16-18 yielded nodes are associated with better overall survival compared to neck dissections with lower yields. AIMS We aimed to identify factors affecting the lymph node yield and density in patients with oral cavity cancer undergoing elective neck dissection levels 1-3. MATERIALS AND METHODS Using prospectively registered data, we conducted a population-based cohort study on all patients surgically treated for oral cavity cancer including levels 1-3 neck dissection at our institution from 2018 to 2022. Uni and multivariate analyses were performed to identify factors associated with lymph node yields. RESULTS In total, 221 patients were included. The mean lymph nodes yield and density were 19 (95%CI 18-20) and 0.12 (95%CI 0.09-0.16), respectively. In multivariate analysis, increasing body weight (p = .034) was positively and previous radiotherapy (p = .006) were negatively correlated with the number of yielded lymph nodes. Lymph node density was positively correlated with body weight (p = .011) and body mass index (p = .032) in univariate analysis. CONCLUSIONS AND SIGNIFICANCE Increasing body weight was positively and previous radiotherapy was negatively correlated to lymph node yield. These factors should be taken into consideration when interpreting the lymph node yield as an indicator of neck dissection quality.
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Affiliation(s)
- Pelle Hanberg
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Trine Tramm
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Arunas Pikelis
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Sten Schytte
- Department of Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Dürr Gade
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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4
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Struckmeier AK, Buchbender M, Lutz R, Agaimy A, Kesting M. Comparison of the prognostic value of lymph node yield, lymph node ratio, and number of lymph node metastases in patients with oral squamous cell carcinoma. Head Neck 2024; 46:1083-1093. [PMID: 38501325 DOI: 10.1002/hed.27748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The aim of this study was to assess the prognostic significance of lymph node yield (LNY), lymph node ratio (LNR), and the number of lymph node metastases (LNMs) in patients affected by oral squamous cell carcinoma (OSCC). METHODS The study included patients who underwent surgical treatment for primary OSCC. Receiver operating characteristic curves were generated to determine the optimal threshold values. Kaplan-Meier curves were employed, along with the log-rank test, for the analysis of survival. To compare the performance in terms of model fit, we computed Akaike's information criterion (AIC). RESULTS This study enrolled 429 patients. Prognostic thresholds were determined at 22 for LNY, 6.6% for LNR, and 3 for the number of LNMs. The log-rank test revealed a significant improvement in both overall survival and progression-free survival for patients with a LNR of ≤6.6% or a number of LNMs of ≤3 (p < 0.05). Interestingly, LNY did not demonstrate prognostic significance. The AIC analyses indicated that the number of LNMs is a superior prognostic indicator compared to LNY and LNR. CONCLUSIONS Incorporating LNR or the number of LNMs into the TNM classification has the potential to improve the prognostic value, as in other types of cancers. Particularly, the inclusion of the number of LNMs should be contemplated for future N staging.
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Affiliation(s)
- Ann-Kristin Struckmeier
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Mayte Buchbender
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Abbas Agaimy
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marco Kesting
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
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5
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Matos LL, Kowalski LP, Chaves ALF, de Oliveira TB, Marta GN, Curado MP, de Castro Junior G, Farias TP, Bardales GS, Cabrera MA, Capuzzo RDC, de Carvalho GB, Cernea CR, Dedivitis RA, Dias FL, Estefan AM, Falco AH, Ferraris GA, Gonzalez-Motta A, Gouveia AG, Jacinto AA, Kulcsar MAV, Leite AK, Lira RB, Mak MP, De Marchi P, de Mello ES, de Matos FCM, Montero PH, de Moraes ED, de Moraes FY, Morais DCR, Poenitz FM, Poitevin A, Riveros HO, Sanabria Á, Ticona-Castro M, Vartanian JG, Viani G, Vines EF, William Junior WN, Conway D, Virani S, Brennan P. Latin American Consensus on the Treatment of Head and Neck Cancer. JCO Glob Oncol 2024; 10:e2300343. [PMID: 38603656 DOI: 10.1200/go.23.00343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 04/13/2024] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.
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Affiliation(s)
- Leandro Luongo Matos
- Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | - Gilberto de Castro Junior
- Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Andrés Munyo Estefan
- Profesor Adjunto Catedra de Otorrinolaringologia del Hospital de Clínicas, Montevidéu, Uruguay
| | | | | | | | - Andre Guimarães Gouveia
- Juravinski Cancer Centre, Department of Oncology, Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | | | - Marco Aurelio Vamondes Kulcsar
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Ana Kober Leite
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Renan Bezerra Lira
- AC Camargo Cancer Center and Hospital Albert Einstein, São Paulo, Brazil
| | - Milena Perez Mak
- 3Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | | | | | | | - Pablo H Montero
- Department of Surgical Oncology and Head and Neck Surgery, Division of Surgery, P. Universidad Católica de Chile, Santiago, Chile
| | | | | | | | | | | | | | - Álvaro Sanabria
- 4Department of Surgery, Universidad de Antioquia, Hospital Alma Mater, Medellin, Colombia
| | - Miguel Ticona-Castro
- 5ESMO Member, Peruvian Society of Medical Oncology (S.P.O.M.) Member, La Molina, Peru
| | - José Guilherme Vartanian
- 6Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Gustavo Viani
- 7Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Eugenio F Vines
- Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | | | - Shama Virani
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| | - Paul Brennan
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
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Yaniv D, Seiwert TY, Margalit DN, Williams MD, Barbon CEA, Largo RD, Smith JA, Gross ND. Neoadjuvant chemotherapy for advanced oral cavity cancer. CA Cancer J Clin 2024. [PMID: 38329372 DOI: 10.3322/caac.21829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024] Open
Affiliation(s)
- Dan Yaniv
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tanguy Y Seiwert
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Danielle N Margalit
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle D Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carly E A Barbon
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rene D Largo
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Neil D Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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7
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Eskander A, Dziegielewski PT, Patel MR, Jethwa AR, Pai PS, Silver NL, Sajisevi M, Sanabria A, Doweck I, Khariwala SS, St John M. Oral Cavity Cancer Surgical and Nodal Management: A Review From the American Head and Neck Society. JAMA Otolaryngol Head Neck Surg 2024; 150:172-178. [PMID: 38153725 DOI: 10.1001/jamaoto.2023.4049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Importance Lymph node metastases from oral cavity cancers are seen frequently, and there is still inconsistency, and occasional controversies, regarding the surgical management of the neck in patients with oral cancer. This review is intended to offer a surgically focused discussion of the current recommendations regarding management of the neck, focusing on the indications and extent of dissection required in patients with oral cavity squamous cell carcinoma while balancing surgical risk and oncologic outcome. Observations The surgical management of the neck for oral cavity cancer has been robustly studied, as evidenced by substantial existing literature surrounding the topic. Prior published investigations have provided a sound foundation on which data-driven treatment algorithms can generally be recommended. Conclusions Existing literature suggests that patients with oral cavity cancer should be fully staged preoperatively, and most patients should receive a neck dissection even when clinically N0. Quality standards supported by the literature include separation of each level during specimen handling and lymph node yield of 18 or more nodes. Sentinel lymph node biopsy can be considered in select tumors and within a well-trained multidisciplinary team.
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Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville
| | - Mihir R Patel
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | - Ashok R Jethwa
- Department of Otolaryngology-Head and Neck, University of Minnesota Medical School, Minneapolis
| | - Prathamesh S Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Mirabelle Sajisevi
- Department of Otolaryngology, The University of Vermont Medical Center, Burlington
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Ilana Doweck
- Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Rappaport School of Medicine, Technion, Haifa, Israel
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck, University of Minnesota Medical School, Minneapolis
| | - Maie St John
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California
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8
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Xie X, Kang M, Qu Z, Gu K. A predictive model for patients with local-regionally advanced oropharyngeal squamous cell carcinoma treated after cervical lymph node dissection. J Cancer Res Clin Oncol 2023; 149:17241-17251. [PMID: 37804427 DOI: 10.1007/s00432-023-05379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/30/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE To develop a nomogram to predict the cancer-specific survival of patients with local-regionally advanced oropharyngeal squamous cell carcinoma after cervical lymph node dissection. METHODS The clinical variables of patients confirmed as having oropharyngeal squamous cell carcinoma between 2008 and 2015 were retrieved from the Surveillance, Epidemiology and End Results database. Univariate and multivariate analysis were performed, followed by the construction of nomograms for CSS. Nomogram' accuracy was evaluated through the concordance index, calibration curves and decision curve analysis. RESULTS A total of 1994 oropharyngeal squamous cell carcinoma patients who underwent surgery were included in this study. Sex, T-stage, American Joint Committee on Cancer-stage, positive lymph nodes, positive lymph node ratio, log odds of positive lymph nodes, and postoperative radiotherapy were selected to establish the nomogram for oropharyngeal squamous cell carcinoma. The concordance index of the nomogram was 0.747 (95% CI 0.714-0.780) in the training calibration cohort and 0.735 (95% CI 0.68-0.789) in the validationcohort and the time-dependent Area under the curve (> 0.7) indicated satisfactory discriminative ability of the nomogram. The calibration plot shows that there is a good consistency between the predictions of the nomogram and the actual observations in the training and validation cohorts. In addition, decision curve analysis showed that the nomogram was clinically useful and had a better ability to recognize patients at high risk than the American Joint Committee on Cancer tumor-node-metastasis staging. CONCLUSION The predictive model has the potential to provide valuable guidance to clinicians in the treatment of patients with locoregionally advanced OPSCC confined to the cervical lymph nodes.
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Affiliation(s)
- Xiaoque Xie
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mei Kang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ziting Qu
- Department of Medical Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kangsheng Gu
- Department of Medical Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
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9
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Liokatis P, Obermeier KT, Trautner F, Kraus M, Smolka W, Troeltzsch M, Otto S, Haidari S. Comparison of alternative N-staging models in patients with oral cancer. Is nodal yield or burden the most critical parameter? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101594. [PMID: 37562715 DOI: 10.1016/j.jormas.2023.101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND There is increasing evidence in the literature that alternative N-classification systems offer a simpler and more precise risk stratification than the current N- classification in patients with oral squamous cell carcinoma. The purpose of this study is to compare three broadly proposed models incorporating lymph node ratio, log odds of positive lymph nodes and number of positive lymph nodes regarding disease-free and overall survival. METHODS This is a retrospective study of patients treated in a single center between 2013 and 2019. Cox proportional hazard models, Kaplan Meier curves, the long rank test and the area under the curve were implemented to compare the risk-stratification ability of the three models. Moreover, a hazard ratio plot was calculated to investigate the association between nodal yield and disease-free survival. RESULTS 231 patients were included. All three proposed N-models were significantly correlated to the patient's prognosis in the multivariate analysis. Pairwise comparisons between the groups showed that the current pN classification offers the worst stratification and that the model incorporating the number of positive lymph nodes had a better performance for predicting both endpoints. Finally, a decrease in hazard ratio was observed with each additional lymph node removed up to the number of 39 lymph nodes. CONCLUSIONS The model incorporating the nodal burden offered a better predictive ability. The current N-classification cannot adequately identify patients with different prognosis. A non-linear relationship was found between nodal yield and survival, which could be the disadvantage of the lymph node ratio and log odds models.
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Affiliation(s)
- Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany
| | - Katharina Theresa Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany
| | - Fabienne Trautner
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany.
| | - Moritz Kraus
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany
| | - Wenko Smolka
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany
| | - Matthias Troeltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany
| | - Selgai Haidari
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany
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10
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Stampe H, Jakobsen KK, Tvedskov JF, Wessel I, Kiss K, Friborg J, Andersen AO, Grønhøj C, von Buchwald C, Christensen A. Prognostic Value of Lymph Node Yield, Lymph Node Density, and pN in Oral Cancer. Otolaryngol Head Neck Surg 2023; 169:276-285. [PMID: 36066971 DOI: 10.1177/01945998221123927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate thresholds for lymph node yield (LNY), lymph node density (LND), and pN in patients with oral squamous cell carcinoma in relation to previous findings in the literature. STUDY DESIGN Retrospective register-based study. SETTING Copenhagen Oral Cavity Squamous Cell Carcinoma database. METHODS Appropriate thresholds for LNY, LND, and pN were determined by areas under the curve and subsequently subjected to multivariate analysis. Five-year overall survival and 3-year recurrence-free survival were determined by Kaplan-Meier survival curves. RESULTS In total, 413 patients diagnosed with oral squamous cell carcinoma were included. In the pN0 cohort, no superior/prognostic LNY cutoff values were detected. In the pN+ cohort, areas under the curve determined thresholds of LNY, LND, and pN to be 21 nodes, 5%, and 3 metastases, respectively. The 5-year overall survival was 52% for patients with LNY ≥21 vs 38% for patients with LNY <21 (hazard ratio [HR], 1.49; 95% CI, 1.05-2.11; P < .05), 60% for patients with LND ≤5% vs 38% for patients with LND >6% (HR, 1.63; 95% CI, 1.03-2.57; P < .05), and 43% for patients with pN <3 vs 26% for patients with pN ≥3 (HR, 1.40; 95% CI, 1.04-2.15; P < .05). CONCLUSIONS Increased nodal yield, decreased LND, and decreasing number of pN were associated with significantly improved survival outcomes. LNY might serve as a prognosticator of survival as well as a surgical quality indicator. LND may have implications as a tool in cancer staging and treatment planning.
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Affiliation(s)
- Helene Stampe
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Kathrine Kronberg Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Jesper Filtenborg Tvedskov
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Katalin Kiss
- epartment of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Jeppe Friborg
- Department of Clinical Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Amanda Oester Andersen
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Anders Christensen
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
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11
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Hintze J, Lang B, Subramaniam T, Kruseman N, O'Regan E, Brennan S, Lennon P. Factors influencing nodal yield in neck dissections for head and neck malignancies. J Laryngol Otol 2023; 137:925-929. [PMID: 36651334 DOI: 10.1017/s0022215122002687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE A standard lateral neck dissection should yield at least 18 lymph nodes. The goal of the present study was to examine what factors might influence the number of lymph nodes retrieved during a neck dissection. METHODS This was a retrospective cohort study in a tertiary academic referral centre for head and neck oncology. Two hundred and nineteen consecutive neck dissections were examined. Age of the patient and primary site were recorded, along with tumour histology, previous radiotherapy and final nodal count. RESULTS The mean age was 62.2 ± 13.0 years. The most common primary site was the oral cavity (38.8 per cent). The mean number of lymph nodes was 30.63 ± 13.9. In total, 17.8 per cent had undergone previous radiotherapy. The mean number of lymph nodes was 33.26 ± 13.27 in patients with no previous radiation exposure and 18.47 ± 9.46 in those with previous radiation treatment. CONCLUSION Lymph node yield from a neck dissection is likely multi-factorial in nature. Previous radiotherapy, the only significant contributor, led to a mean reduction of lymph node yield from 33.3 to 18.5.
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Affiliation(s)
- J Hintze
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - B Lang
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - T Subramaniam
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - N Kruseman
- Department of Histopathology, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - E O'Regan
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Department of Histopathology, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - S Brennan
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Department of Radiation Oncology, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - P Lennon
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
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12
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Zhuge L, Cai H, Huang Z, Wang S, Li Z. The optimal number of examined lymph nodes for accurate nodal staging and favorable prognosis of oral tongue squamous cell carcinoma. Oral Oncol 2023; 140:106368. [PMID: 36966671 DOI: 10.1016/j.oraloncology.2023.106368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/19/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE The study aimed to determine the optimal count of examined lymph nodes (ELN) for accurate assessment of lymph node status and favorable long-term survival in patients with oral tongue squamous cell carcinoma (OTSCC) who received radical resection. METHODS Patients with OTSCC who received radical resection between 2004 and 2015 were enrolled from the Surveillance, Epidemiology, and End Results database (SEER) and were randomly divided into two cohorts. The association of ELN count with nodal migration and overall survival (OS) was analyzed using a multivariate regression model with the adjustment of relevant factors. Locally weighted scatterplot smoothing (LOWESS) and 'strucchange' package were adopted to identify the optimal cut points using R. RESULTS A total of 2077 patients were included in this study. The optimal cut points of ELN count for accurate nodal staging and favorable OS were 19 and 15, respectively. The probability of detecting positive lymph nodes (PLN) significantly increased in patients with ELN count ≥ 19 in comparison to those with ELN count < 19 (training set, P < 0.001; validation set, P = 0.012). A better postoperative prognosis was observed in patients with ELN count ≥ 15 than those with fewer ELN (training set, P = 0.001, OR: 0.765; validation set, P = 0.016, OR: 0.678). CONCLUSION The optimal cut point of ELN count to ensure the accuracy of nodal staging and to achieve a favorable postoperative prognosis were 19 and 15, respectively. The ELN count beyond the cutoff values might improve the accuracy of cancer staging and OS.
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Affiliation(s)
- Lingdun Zhuge
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huizhu Cai
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zehao Huang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shixu Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengjiang Li
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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13
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Yu ST, Ge J, Wei Z, Sun B, Xiao Z, Li T, Zhang Z, Chen W, Lei ST. The lymph node yield in the initial lateral neck dissection predicts recurrence in the lateral neck of papillary thyroid carcinoma: a revision surgery cohort study. Int J Surg 2023; 109:1264-1270. [PMID: 37080561 PMCID: PMC10389610 DOI: 10.1097/js9.0000000000000316] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/20/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND This study aimed to evaluate the relationship between lateral lymph node yield (LLNY) and the ratio of lateral positive lymph nodes to lymph node yield (LPLR) from initial lateral neck dissection (LND) in patients with papillary thyroid carcinoma (PTC), as well as the risk of recurrence in patients undergoing LND reoperations. METHODS This retrospective cohort study enrolled patients with PTC who underwent revision LND between 1 January 2012, and 31 December 2021. The initial and revised clinical data were retrieved. Patient demographics, clinicopathological features, clinical records, and follow-up information were also reviewed. LLNY and LPLR were determined during the initial LND. RESULTS In total, 156 patients with PTC were included in this study, with a median follow-up of 36.5 months; 107 had recurrent lateral neck disease. The optimal LLNY and LPLR cutoff values for recurrent/persistent disease were 24.5 and 32.74%, respectively. The high-risk group (LLNY<25) had the lowest recurrence-free survival rate compared with to moderate-risk group (LLNY≥25, LPLR≥32.74%) and low-risk group (LLNY≥25, LPLR<32.74%) ( P <0.001). The moderate-risk group had lower recurrence-free survival than the low-risk group. Multivariate analysis revealed that an LLNY less than 25 in the initial LND was an independent risk factor for recurrence/persistence of lateral neck ( P <0.001). CONCLUSIONS This study identified that LLNY and LPLR were associated with recurrence/persistence in PTC patients at the time of revision surgery was performed.
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Affiliation(s)
- Shi-Tong Yu
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, the First School of Clinical Medicine, Southern Medical University
| | - Junna Ge
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, the First School of Clinical Medicine, Southern Medical University
| | - Zhigang Wei
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, the First School of Clinical Medicine, Southern Medical University
| | - Baihui Sun
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, the First School of Clinical Medicine, Southern Medical University
| | - Zizheng Xiao
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China
| | - Tingting Li
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, the First School of Clinical Medicine, Southern Medical University
| | - Zhicheng Zhang
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, the First School of Clinical Medicine, Southern Medical University
| | - Weisheng Chen
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, the First School of Clinical Medicine, Southern Medical University
| | - Shang-Tong Lei
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, the First School of Clinical Medicine, Southern Medical University
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14
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Saraswathula A, Austin JM, Fakhry C, Vosler PS, Mandal R, Koch WM, Tan M, Eisele DW, Frick KD, Gourin CG. Surgeon Volume and Laryngectomy Outcomes. Laryngoscope 2023; 133:834-840. [PMID: 35634691 PMCID: PMC9708934 DOI: 10.1002/lary.30229] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/11/2022] [Accepted: 05/12/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the relationship between surgeon volume and operative morbidity and mortality for laryngectomy. DATA SOURCES The Nationwide Inpatient Sample was used to identify 45,156 patients who underwent laryngectomy procedures for laryngeal or hypopharyngeal cancer between 2001 and 2011. Hospital and surgeon laryngectomy volume were modeled as categorical variables. METHODS Relationships between hospital and surgeon volume and mortality, surgical complications, and acute medical complications were examined using multivariable regression. RESULTS Higher-volume surgeons were more likely to operate at large, teaching, nonprofit hospitals and were more likely to treat patients who were white, had private insurance, hypopharyngeal cancer, low comorbidity, admitted electively, and to perform partial laryngectomy, concurrent neck dissection, and flap reconstruction. Surgeons treating more than 5 cases per year were associated with lower odds of medical and surgical complications, with a greater reduction in the odds of complications with increasing surgical volume. Surgeons in the top volume quintile (>9 cases/year) were associated with a decreased odds of in-hospital mortality (OR = 0.09 [0.01-0.74]), postoperative surgical complications (OR = 0.58 [0.45-0.74]), and acute medical complications (OR = 0.49 [0.37-0.64]). Surgeon volume accounted for 95% of the effect of hospital volume on mortality and 16%-47% of the effect of hospital volume on postoperative morbidity. CONCLUSION There is a strong volume-outcome relationship for laryngectomy, with reduced mortality and morbidity associated with higher surgeon and higher hospital volumes. Observed associations between hospital volume and operative morbidity and mortality are mediated by surgeon volume, suggesting that surgeon volume is an important component of the favorable outcomes of high-volume hospital care. Laryngoscope, 133:834-840, 2023.
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Affiliation(s)
- Anirudh Saraswathula
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J. Matthew Austin
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peter S. Vosler
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rajarsi Mandal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wayne M. Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marietta Tan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David W. Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kevin D. Frick
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins Carey Business School, Baltimore, MD
| | - Christine G. Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD
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15
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Li J, Xu Y, Zhang J, Wang S, Wang X, Guo H, Miao G. Prognostic value of the nodal yield in oral squamous cell carcinoma: a systematic review and meta-analysis. Expert Rev Anticancer Ther 2023; 23:339-345. [PMID: 36645663 DOI: 10.1080/14737140.2023.2168648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To systematically evaluate the prognostic value of the nodal yield in oral squamous cell carcinoma by meta-analysis. METHODS The meta-analysis was adherence to PRISMA. We searched MEDLINE, Embase, and Cochrane for studies published up to 20 April 2022. We collected evidences from observational studies regarding nodal yield in oral squamous cell carcinoma, and investigated its prognostic value by the routine methods of meta-analysis. RESULTS From seven studies, there was no significant impact of the lymph node yield on overall survival among patients with oral squamous cell carcinoma cases and <18 lymph nodes (hazard ratio (HR) = 1.019, 95% confidence interval (CI) = 0.786-1.320, p = 0.887), with significant heterogeneity (I2 = 80%). The pooled result indicated that a > 18-lymph node yield was a favorable prognostic factor (HR = 0.786, 95%CI = 0.646-0.956, p = 0.016; I2 = 39%). The lymph node yield was not associated with disease-specific survival (HR = 1.594, 95%CI = 0.996-2.552, p = 0.052; I2 = 81%) or disease-free survival (HR = 1.508, 95%CI = 0.924-2.460, p = 0.100; I2 = 41%). CONCLUSION A lymph node yield of ≥18 lymph nodes might be a favorable prognostic factor for the overall survival of patients with oral squamous cell carcinoma.
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Affiliation(s)
- Jiajia Li
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Yubo Xu
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Jie Zhang
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Shaohai Wang
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Xiaoyu Wang
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Huayan Guo
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Guojun Miao
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
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16
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Nayak SP, Sreekanth Reddy V, Gangadhara B, Sadhoo A. Efficacy and Safety of Novel Minimally Invasive Neck Dissection Techniques in Oral/Head and Neck Cancer: A Systematic Review and Meta-Analysis. Indian J Otolaryngol Head Neck Surg 2022; 74:2166-2176. [PMID: 36452741 PMCID: PMC9702110 DOI: 10.1007/s12070-020-02066-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022] Open
Abstract
Despite minimally invasive neck dissection (MIND) being popular technique, there is a paucity of literature emphasizing its safety and efficacy. In this meta-analysis, we compared the efficacy and safety of MIND over CND techniques in treating oral/head and neck cancer. We systematically searched PubMed, MEDLINE, Embase, from database inception to January, 2019 for the relevant studies comparing MIND and CND. Two independent reviewers performed quality check and data were extracted for primary outcomes to assess length of hospital stay, duration of surgery, intraoperative blood loss and retrieved lymph nodes. Drainage volume and duration, length of incision, satisfaction of scar and safety were the secondary outcomes. We analyzed the outcomes using standard mean differences (SMDs) and the relative risk that were pooled using random effect meta-analysis. Out of 144 studies, 17 met the final inclusion criteria. MIND technique has shown better overall efficacy with outcomes compared to CND except with duration of surgery (SMD 1.82, 95% CI 0.47-3.17). Lesser hospital stay, better nodal yield and less intra-operative blood loss was observed with MIND over CND. Duration and volume of wound drainage was comparably less in MIND with smaller length of incision. Postoperative complications were less and tolerable with MIND approach with superior cosmetic outcomes. MIND via endoscopic or robotic approach is safe and efficacious with equitable oncological outcomes in terms of lymph nodes yield compared to CND, but it requires longer surgery duration.
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Affiliation(s)
- Sandeep P. Nayak
- Surgical Oncology, Fortis Hospital, 154, 9, Bannerghatta Main Rd, Opposite IIM, Sahyadri Layout, Panduranga Nagar, Bengaluru, Karnataka 560076 India
| | - V. Sreekanth Reddy
- Surgical Oncology, Fortis Hospital, 154, 9, Bannerghatta Main Rd, Opposite IIM, Sahyadri Layout, Panduranga Nagar, Bengaluru, Karnataka 560076 India
| | - Bharath Gangadhara
- Surgical Oncology, Fortis Hospital, 154, 9, Bannerghatta Main Rd, Opposite IIM, Sahyadri Layout, Panduranga Nagar, Bengaluru, Karnataka 560076 India
| | - Abhilasha Sadhoo
- Surgical Oncology, Fortis Hospital, 154, 9, Bannerghatta Main Rd, Opposite IIM, Sahyadri Layout, Panduranga Nagar, Bengaluru, Karnataka 560076 India
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17
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Farrokhian N, Holcomb AJ, Dimon E, Karadaghy O, Ward C, Whiteford E, Tolan C, Hanly EK, Buchakjian MR, Harding B, Dooley L, Shinn J, Wood CB, Rohde S, Khaja S, Parikh A, Bulbul MG, Penn J, Goodwin S, Bur AM. Assessing Prognostic Value of Quantitative Neck Dissection Quality Measures in Patients With Clinically Node-Negative Oral Cavity Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2022; 148:947-955. [PMID: 36074415 PMCID: PMC9459899 DOI: 10.1001/jamaoto.2022.2312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/05/2022] [Indexed: 11/14/2022]
Abstract
Importance In clinically localized (T1-2) oral cavity squamous cell carcinoma (OCSCC), regional lymph node metastasis is associated with a poor prognosis. Given the high propensity of subclinical nodal disease in these patients, upfront elective neck dissections (END) for patients with clinically node-negative disease are common and associated with better outcomes. Unfortunately, even with this risk-adverse treatment paradigm, disease recurrence still occurs, and our understanding of the factors that modulate this risk and alter survival have yet to be fully elucidated. Objective To investigate the prognostic value of lymph node yield (LNY), lymph node ratio (LNR), and weighted LNR (wLNR) in patients with clinically node-negative T1-2 OCSCC. Design, Setting, and Participants In this cohort study, data were collected retrospectively from 7 tertiary care academic medical centers. Overall, 523 patients with cT1-2N0 OCSCC who underwent elective neck dissections after primary surgical extirpation were identified. Exposures Lymph node yield was defined as the number of lymph nodes recovered from elective neck dissection. Lymph node ratio was defined as the ratio of positive nodes against total LNY. Weighted LNR incorporated information from both LNY and LNR into a single continuous metric. Main Outcomes and Measures Locoregional control (LRC) and disease-free survival (DFS) were both evaluated using nonparametric Kaplan-Meier estimators and semiparametric Cox regression. Results On multivariable analysis, LNY less than or equal to 18 lymph nodes was found to be significantly associated with decreased LRC (aHR, 1.53; 95% CI, 1.04-2.24) and DFS (aHR, 1.46; 95% CI, 1.12-1.92) in patients with pN0 disease, but not those with pN-positive disease. Importantly, patients with pN0 disease with LNY less than or equal to 18 and those with pN1 diseasehad nearly identical 5-year LRC (69.7% vs 71.4%) and DFS (58.2% vs 55.7%). For patients with pN-positive disease, LNR greater than 0.06 was significantly associated with decreased LRC (aHR, 2.66; 95% CI, 1.28-5.55) and DFS (aHR, 1.65; 95% CI, 1.07-2.53). Overall, wLNR was a robust prognostic variable across all patients with cN0 disease, regardless of pathologic nodal status. Risk stratification via wLNR thresholds demonstrated greater optimism-corrected concordance compared with American Joint Committee on Cancer (AJCC) 8th edition nodal staging for both LRC (0.61 vs 0.57) and DFS (0.61 vs 0.58). Conclusions and Relevance Movement toward more robust metrics that incorporate quantitative measures of neck dissection quality and regional disease burden, such as wLNR, could greatly augment prognostication in cT1-2N0 OCSCC by providing more reliable and accurate risk estimations.
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Affiliation(s)
- Nathan Farrokhian
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Andrew J. Holcomb
- Department of Otolaryngology, Nebraska Methodist Health System, Omaha
| | - Erin Dimon
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Omar Karadaghy
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Christina Ward
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Erin Whiteford
- Department of Otolaryngology, Nebraska Methodist Health System, Omaha
| | - Claire Tolan
- Department of Otolaryngology, Nebraska Methodist Health System, Omaha
| | - Elyse K. Hanly
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa, Iowa City
| | - Marisa R. Buchakjian
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa, Iowa City
| | - Brette Harding
- Department of Otolaryngology–Head and Neck Surgery, University of Missouri, Columbia
| | - Laura Dooley
- Department of Otolaryngology–Head and Neck Surgery, University of Missouri, Columbia
| | - Justin Shinn
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee
| | - C. Burton Wood
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee
| | - Sarah Rohde
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee
| | - Sobia Khaja
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis
| | - Anuraag Parikh
- Department of Otolaryngology–Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York
| | - Mustafa G. Bulbul
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Joseph Penn
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Sara Goodwin
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Andrés M. Bur
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
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18
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Voss JO, Freund L, Neumann F, Mrosk F, Rubarth K, Kreutzer K, Doll C, Heiland M, Koerdt S. Prognostic value of lymph node involvement in oral squamous cell carcinoma. Clin Oral Investig 2022; 26:6711-6720. [PMID: 35895143 PMCID: PMC9643253 DOI: 10.1007/s00784-022-04630-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/12/2022] [Indexed: 12/24/2022]
Abstract
Objectives Different parameters have been identified in patients with oral squamous cell carcinomas (OSCC) that have a serious impact on survival, including residual tumour and extracapsular spread. Moreover, other factors, including the lymph node ratio (LNR) and lymph node yield (LNY), have been suggested as prognostic markers. Material and methods This retrospective study included patients diagnosed with OSCC and cervical lymph node metastases during the years 2010–2020. Patients’ records were evaluated regarding lymph node status, final therapy regime, tumour recurrence, time to death, tumour association with death, disease-free survival (DSF), and overall survival (OS). Results In 242 patients with a mean age of 63.57 ± 11.24 years, treated either by selective neck dissection (SND; n = 70) or by modified radical neck dissection (MRND; n = 172), 5772 lymph nodes were detected. The LNR and LNY were identified as independent risk factors in OS and DFS. The optimal cut-off point for the LNY was ≥ 17 lymph nodes in the SND and ≥ 27 lymph nodes in the MRND group. The metastatic lymph node clearance (MLNC) was established as a score to relate the LNR and LNY to the extent of lymph node removal. Survival analysis showed statistically significant differences among score levels. Conclusions As information about the extent of nodal dissection is excluded from LNR and LNY, we propose the use of a new scoring system comprising individual cut-off values for LNY and LNR with regard to the extent of neck dissection. Clinical Relevance MLNC might help to identify high-risk OSCC patients with metastatic lymph nodes.
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Affiliation(s)
- Jan Oliver Voss
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany. .,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - Lea Freund
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Neumann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Friedrich Mrosk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Kerstin Rubarth
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117, Berlin, Germany
| | - Kilian Kreutzer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christian Doll
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Max Heiland
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Steffen Koerdt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
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Ramos JPZ, Machado FR, Merhi VAL, Aquino JLBDE. Prognostic analysis of lymph node ratio of patients with disease recurrence previously submitted to cervical dissection surgery for head and neck cancer. Rev Col Bras Cir 2022; 49:e20223178. [PMID: 35674632 PMCID: PMC10578812 DOI: 10.1590/0100-6991e-20223178-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/22/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION the variable lymph node ratio has recently been studied as a possible influencer in the survival of patients diagnosed with head and neck cancer. OBJECTIVE to analyze the correlation between lymph node density and survival of recurred disease patients previously submitted to cervical dissection surgery due to head and neck squamous cell carcinoma. METHOD we retrospectively analyzed 71 medical records of patients treated at the Head and Neck Surgery Service of the Pontifícia Universidade Católica de Campinas who had undergone cervical dissection surgery and presented tumor recurrence between 2006 and 2019. Patient and tumor data such as age, gender, skin color, smoking, alcohol consumption, location of the primary tumor, anatomopathological characteristics and lymph node status were correlated with the survival time. RESULTS we found a predominance of males and the mean age was 59.5 years. The most frequent primary site was the oral cavity followed by the larynx and oropharynx. The mortality rate was 53.52% and the mean lymph node ratio 0.28. We found influence on survival with statistical significance for the parameters: lymph node ratio, number of dissected and affected lymph nodes, T and N staging, type of treatment proposed (palliative or surgical), presence of compromited margins in the primary tumor and lymph node extravasation. CONCLUSION the calculation of lymph node density in patients with recurred disease after cervical dissection surgery by head and neck squamous cell carcinoma should be taken into account during therapeutic planning and prognostic evaluation due to its direct influence on the survival.
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Affiliation(s)
- João Paulo Zenun Ramos
- - Pontifícia Universidade Católica de Campinas, Cirurgia de Cabeça e Pescoço - Campinas - SP - Brasil
| | - Felipe Raule Machado
- - Pontifícia Universidade Católica de Campinas, Cirurgia de Cabeça e Pescoço - Campinas - SP - Brasil
| | | | - José Luís Braga DE Aquino
- - Pontifícia Universidade Católica de Campinas, Cirurgia de Cabeça e Pescoço - Campinas - SP - Brasil
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20
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RAMOS JOÃOPAULOZENUN, MACHADO FELIPERAULE, MERHI VANIAAPARECIDALEANDRO, AQUINO JOSÉLUÍSBRAGADE. Análise prognóstica da densidade linfonodal de pacientes recidivados previamente submetidos à cirurgia de esvaziamento cervical por neoplasia de cabeça e pescoço. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Introdução: recentemente tem-se estudado a variável densidade linfonodal como possível influenciador na sobrevida de pacientes com diagnóstico de câncer de cabeça e pescoço. Objetivo: analisar a relação entre a densidade linfonodal e a sobrevida de pacientes recidivados previamente submetidos a cirurgia de esvaziamento cervical por carcinoma espinocelular de cabeça e pescoço. Método: foram analisados retrospectivamente 71 prontuários pacientes atendidos no Serviço de Cirurgia de Cabeça e Pescoço da Pontifícia Universidade Católica de Campinas que tinham sido submetidos a cirurgia de esvaziamento cervical e apresentaram recidiva tumoral entre os anos de 2006 e 2019. Dados relativos ao paciente e ao tumor tais como: idade, sexo, cor da pele, tabagismo, etilismo, localização do tumor primário, características anatomopatológicas e status linfonodal foram correlacionados ao tempo de sobrevida dos indivíduos. Resultados: encontramos predominância do sexo masculino e a média de idade foi de 59,5 anos. O sítio primário mais frequente foi a cavidade oral seguido da laringe e orofaringe. A taxa de mortalidade foi de 53,52% e a densidade linfonodal média 0,28. Encontramos influência na sobrevida com significância estatística para os parâmetros: densidade linfonodal, número de linfonodos dissecados e acometidos, estadiamento T e N, tipo de tratamento proposto (paliativo ou cirúrgico), presença de margens comprometidas no tumor primário e extravasamento linfonodal. Conclusão: o cálculo da densidade linfonodal em pacientes recidivados após cirurgia de esvaziamento cervical por carcinoma espinocelular de cabeça e pescoço deve ser levado em consideração durante o planejamento terapêutico e na avaliação prognóstica devido à sua direta influencia na sobrevida dos indivíduos.
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21
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Mamic M, Lucijanic M, Lorencin M, Suton P, Luksic I. Impact of lymph node ratio on survival and recurrence outcomes in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2022; 51:1257-1263. [DOI: 10.1016/j.ijom.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/29/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
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22
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Thomas RJ, Whittaker J, Pollock J. Discerning a smile - The intricacies of analysis of post-neck dissection asymmetry. Am J Otolaryngol 2022; 43:103271. [PMID: 34800862 DOI: 10.1016/j.amjoto.2021.103271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Iatrogenic facial nerve palsy is distressing to the patient and clinician. The deformity is aesthetically displeasing, and can be functionality problematic for oral competence, dental lip trauma and speech. Furthermore such injuries have litigation implications. Marginal mandibular nerve (MMN) palsy causes an obvious asymmetrical smile. MMN is at particular risk during procedures such as rhytidoplasties, mandibular fracture, tumour resection and neck dissections. Cited causes for the high incidence are large anatomical variations, unreliable landmarks, an exposed neural course and tumour grade or nodal involvement dictating requisite nerve sacrifice. An alternative cause for post-operative asymmetry is damage to the cervical branch of the facial nerve or platysmal dysfunction due to its division. The later tends to have a transient course and recovers. Distinction between MMN palsy and palsy of the cervical branch of the facial nerve or platysma division should therefore be made. In 1979 Ellenbogen differentiated between MMN palsy and "Pseudo-paralysis of the mandibular branch of the facial nerve". Despite this, there is paucity in the literature & confusion amongst clinicians in distinguishing between these palsies, and there is little regarding these post-operative sequelae and neck dissections. METHOD This article reflects on the surgical anatomy of the MMN and cervical nerve in relation to danger zones during lymphadenectomy. The authors review the anatomy of the smile. Finally, case studies are utilised to evaluate the differences between MMN palsy and its pseudo-palsy to allow clinical differentiation. CONCLUSION Here we present a simple method for clinical differentiation between these two prognostically different injuries, allowing appropriate reassurance, ongoing therapy & management.
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Affiliation(s)
- R J Thomas
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, United Kingdom of Great Britain and Northern Ireland.
| | | | - J Pollock
- Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom of Great Britain and Northern Ireland.
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23
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Rees CA, Litchman JH, Wu X, Servos MM, Kerr DA, Halter RJ, Pastel DA, Paydarfar JA. CT for estimating adequacy of lymph node dissection in patients with squamous cell carcinoma of the head and neck. Cancer Imaging 2021; 21:61. [PMID: 34802462 PMCID: PMC8607725 DOI: 10.1186/s40644-021-00430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/30/2021] [Indexed: 11/12/2022] Open
Abstract
Background Indices obtained from lymph node dissection specimens, specifically lymph node yield (LNY) and lymph node ratio (LNR), have prognostic significance in the setting of head and neck squamous cell carcinoma (HNSCCa). However, there are currently no validated tools to estimate adequacy of planned lymph node dissection using preoperative data. The present study sought to evaluate CT-derived estimates of lymphatic tissue volumes as a preoperative tool to guide cervical node dissection. Methods Fifteen cervical lymph node dissections were performed in 14 subjects with HNSCCa. Preoperative CT-derived estimates of lymphatic tissue volumes were compared with gross pathology tissue volume estimates and pathologically-determined LNY. Results Resected tissue volume (calculated using the triaxial ellipsoid method) correlates with CT-derived preoperative lymphatic volume estimates (r = 0.74, p = 0.003) while LNY does not(r = − 0.12, p = 0.67). When excluding pathologically enlarged lymph nodes (“refined” data), a negative correlation was observed between refined CT-derived volume estimates and refined LNY (r = − 0.65, p = 0.009). Conclusion In the setting of cervical lymph node dissection, CT-derived lymphatic volume estimates correlate with resected tissue volume, but refined CT-derived volume estimates correlate negatively with refined LNY. Trial registration Retrospectively registered. Level of evidence 4
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Affiliation(s)
| | - Joshua H Litchman
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Xiaotian Wu
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | | | - Darcy A Kerr
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Ryan J Halter
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - David A Pastel
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Joseph A Paydarfar
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA. .,Section of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA.
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Siu J, Griffiths R, Noel CW, Austin PC, Pasternak J, Urbach D, Monteiro E, Goldstein DP, Irish JC, Sawka AM, Eskander A. Surgical Case Volume has an Impact on Outcomes for Patients with Lateral Neck Disease in Thyroid Cancer. Ann Surg Oncol 2021; 29:1141-1150. [PMID: 34705145 DOI: 10.1245/s10434-021-10923-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to assess whether surgical case volume for lateral neck dissection has an impact on the survival of patients who have well-differentiated thyroid cancer (WDTC) with lateral cervical node metastases. The authors used a population-based cohort study design. METHODS The study cohort consisted of WDTC patients in Ontario Canada who underwent thyroidectomy and lateral neck dissection. These patients were identified using both hospital- and surgeon-level administrative data between 1993 and 2017 (n = 1832). Surgeon and hospital volumes were calculated based on the number of cases managed in the year before the procedure by the physician and at the institution managing each case, respectively, and divided into tertiles. Multilevel Cox regression models were used to estimate the effect of volume on disease-free survival (DFS). RESULTS A crude model without patient or treatment characteristics demonstrated that DFS was associated with both higher surgeon volume tertiles (p < 0.01) and higher hospital volume tertiles (p < 0.01). After control for clustering, patient/treatment covariates, and hospital volume, the lowest surgeon volume tertile (range, 0-20/year; mean, 6.5/year) remained an independent statistically significant negative predictor of DFS (hazard ratio, 1.71; 95 % confidence interval, 1.22-2.4; p < 0.01). CONCLUSION Surgeon lateral neck dissection case volume is a predictor of better DFS for thyroid cancer patients, with the lowest surgeon volume tertile (<20 neck dissections per year) demonstrating poorer DFS.
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Affiliation(s)
- Jennifer Siu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Rebecca Griffiths
- ICES, Toronto, ON, Canada.,Cancer Care and Epidemiology, Queens University, Kingston, ON, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
| | - Peter C Austin
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
| | - Jesse Pasternak
- Department of Surgery, Division of General Surgery/Surgical Oncology, University of Toronto, University Health Network, Toronto, ON, Canada
| | - David Urbach
- Womens College Hospital and Departments of Surgery and Health Policy, Management and Evaluation, Womens College Research Institute, University of Toronto, Toronto, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Anna M Sawka
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada. .,ICES, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. .,Department of Otolaryngology-Head and Neck Surgery, Surgical Oncology, Sunnybrook Health Sciences Centre and Michael Garron Hospital, University of Toronto, Toronto, ON, Canada.
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Prognostic value of the nodal yield in elective neck dissections in patients with head and neck carcinomas. Eur Arch Otorhinolaryngol 2021; 279:883-889. [PMID: 33938992 DOI: 10.1007/s00405-021-06819-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The objective of this study is to assess the prognostic capacity of the nodal yield in elective neck dissections performed in patients with head and neck squamous cell carcinomas (HNSCC) without clinical or radiological evidence of regional involvement (cN0) at the time of diagnosis. METHODS Retrospective study including 647 patients with HNSCC treated with an elective neck dissection. RESULTS Patients with < 15 dissected nodes (n = 172, 26.6%) had a 5-year disease-specific survival of 64.9% (95% CI: 57.3-72.5%), while for patients with ≥ 15 dissected nodes (n = 475, 73.4%), it was of 81.9% (95% CI: 78.4-85.4%) (P = 0.0001). The nodal yield category had prognostic capacity on the disease-specific survival in patients with tumors located in the oral cavity (P = 0.001), the oropharynx (P = 0.023) and the hypopharynx (P = 0.034), while for patients with tumors located in the larynx, no significant differences appeared (P = 0.779). Differences in regional recurrence-free survival were also observed based on the nodal yield category in patients with extra-laryngeal tumors (5-year regional recurrence-free survival of 81.0% in patients with < 15 dissected nodes vs 89.0% in patients with ≥ 15 dissected nodes; P = 0.046). CONCLUSION The nodal yield in elective neck dissections in patients without evidence of lymph node disease (cN0) had prognostic capacity depending on the location of the primary tumor. For tumors located in the larynx, the number of dissected nodes did not significantly influence the prognosis. For tumors located in the oral cavity, oropharynx or hypopharynx, patients with < 15 dissected nodes had a disease-specific mortality 2.9 times higher than patients with ≥ 15 dissected nodes.
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Lymph node yield in treatment naïve cases of head and neck squamous cell carcinoma: en bloc lymphadenectomy versus level-by-level dissection. J Laryngol Otol 2021; 135:359-366. [PMID: 33715652 DOI: 10.1017/s0022215121000621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lymph node yield is an important prognostic factor in head and neck squamous cell carcinoma. Variability in neck dissection sampling techniques has not been studied as a determinant of lymph node yield. METHODS This retrospective study used lymph node yield and average nodes per level to compare level-by-level and en bloc neck dissection sampling methods, in primary head and neck squamous cell carcinoma cases operated between March 2017 and February 2020. RESULTS From 123 patients, 182 neck dissections were analysed, of which 133 were selective and the rest were comprehensive: 55 had level-by-level sampling and 127 had undergone en bloc dissection. The level-by-level method yielded more nodes in all neck dissections combined (20 vs 17; p = 0.097), but the difference was significant only for the subcohort of selective neck dissection (18.5 vs 15; p = 0.011). However, the gain in average nodes per level achieved by level-by-level sampling was significant in both groups (4.2 vs 3.33 and 4.4 vs 3, respectively; both p < 0.001). CONCLUSION Sampling of cervical lymph nodes level-by-level yields more nodes than the en bloc technique. Further studies could verify whether neck dissection sampling technique has any impact on survival rates.
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Li P, Fang Q, Yang Y, Chen D, Du W, Liu F, Luo R. Survival Significance of Number of Positive Lymph Nodes in Oral Squamous Cell Carcinoma Stratified by p16. Front Oncol 2021; 11:545433. [PMID: 33747901 PMCID: PMC7969991 DOI: 10.3389/fonc.2021.545433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 02/08/2021] [Indexed: 12/13/2022] Open
Abstract
Objectives: To analyze the significance of the number of positive lymph nodes in oral squamous cell carcinoma (SCC) stratified by p16. Methods: A total of 674 patients were retrospectively enrolled and divided into 4 groups based on their number of positive lymph nodes (0 vs. 1–2 vs. 3–4 vs. ≥5). The Kaplan-Meier method was used to calculate the disease-free survival (DFS) and disease-specific survival (DSS) rates. Cox model was used to evaluate the independent risk factor. Results: p16 showed positivity in 85 patients with a rate of 12.6%. In patients with p16 negativity, the 5-year DFS rates were 52%, 39%, and 21% in patients with 0, 1–2, and 3–4 positive lymph nodes, respectively, in patients with ≥5 positive lymph nodes, all patients developed recurrence within 2 years after operation, the difference was significant; the 5-year DSS rates were 60, 38, and 18% in patients with 0, 1–2, and 3–4 positive lymph nodes, respectively, in patients with ≥5 positive lymph nodes, all patients died within 4-years after operation. The difference was significant. In p16 positivity patients, the 3-year DFS rates were 41% and 17% in patients with 0–2 and ≥3 positive lymph nodes, respectively, the difference was significant; the 3-year DSS rates were 84 and 46% in patients with 0–2 and ≥3 positive lymph nodes, the difference was significant. Conclusions: The number of positive lymph nodes is significantly associated with the survival in oral SCC, its survival effect is not affected by p16 status.
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Affiliation(s)
- Peng Li
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Qigen Fang
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yanjie Yang
- Department of Oral Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Defeng Chen
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Wei Du
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Fei Liu
- Department of Oral Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruihua Luo
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
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Iyer V, Kumar K, Hallikeri K, Desai AK, Kumar N, Natarajan S. Log odds of positive lymph nodes as an independent predictor of overall survival in oral squamous cell carcinoma. J Oral Maxillofac Pathol 2021; 24:576. [PMID: 33967502 PMCID: PMC8083415 DOI: 10.4103/jomfp.jomfp_110_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/05/2020] [Accepted: 08/13/2020] [Indexed: 12/03/2022] Open
Abstract
Context: Log odds of positive lymph nodes (LODDS) have been recently demonstrated as a very promising staging model and have outperformed AJCC pN, lymph node ratio (LNR) category in major cancers. Literature is scarce concerning the prognostic ability of LODDS in oral squamous cell carcinoma (OSCC) patients. Aims: The present study was aimed to evaluate the importance of LODDS in predicting locoregional recurrence and overall survival (OS) in patients with OSCC compared to LNR. Settings and Design: The retrospective study was carried out on 194 patients with OSCC cases treated by surgery ± adjuvant therapy from 2008 to 2014 at our institution. Subjects and Methods: Demographical and clinicopathological details of study cases were recorded. LNR and LODDS were calculated and expressed as a percentage and mean ± standard deviation. Statistical Analysis Used: The OS analysis was done by the Kaplan–Meier curve followed by log-rank (mantel-cox) test. Univariate and multivariate survival analysis was done to analyze the prognostic ability of LNR% and LODDS after adjusting the clinicopathological parameters by the Cox proportional hazards model. Results: Patients with cut off values of LODDS >−1.2 and LNR% >4 had significantly lower mean OS (P ≤ 0.001). Multivariate analysis indicated that only mean LODDS >−1.2 was significantly associated with poor OS. Although there was a correlation with locoregional recurrence, LODDS and LNR failed to be the independent predictors of locoregional recurrence. Conclusions: LODDS was an independent reliable prognostic indicator for patients with OSCCs than conventional staging systems and LNR.
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Affiliation(s)
- Varuni Iyer
- Department of Oral Pathology and Microbiology, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India
| | - Kiran Kumar
- Department of Oral Pathology and Microbiology, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India
| | - Kaveri Hallikeri
- Department of Oral Pathology and Microbiology, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India
| | - Anil Kumar Desai
- SDM Craniofacial Surgery and Research Centre, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India
| | - Niranjan Kumar
- SDM Craniofacial Surgery and Research Centre, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India
| | - Srikant Natarajan
- Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Mangalore, A Constituent Unit of Manipal Academy of Higher Education, Manipal, Karnataka, India
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Yang CC, Kang BH, Liu WS, Yin CH, Lee CC. Postoperative radiotherapy is associated with improved survival in pT1-2N1 oral and oropharyngeal cancer without adequate neck dissection. Radiat Oncol 2021; 16:6. [PMID: 33407647 PMCID: PMC7788971 DOI: 10.1186/s13014-020-01736-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background To assess the benefit of postoperative radiotherapy in patients with pT1-2N1M0 oral and oropharyngeal cancer by the quality of neck dissection. Methods In the Surveillance, Epidemiology, and End Results database, pT1-2N1M0 oral and oropharyngeal cancer patients treated by primary tumor resection and neck dissection with or without radiotherapy were included between 2004 and 2015. Univariate and multivariate analysis were used to explore the effect of adjuvant radiotherapy on 5-year overall survival (OS) and disease-specific survival (DSS) among different quality of neck dissection. Results Of the 1765 patients identified, 1108 (62.8%) had oral cancer, 1141 (64.6%) were men, and 1067 (60.5%) underwent adjuvant radiotherapy. After adjusting for confounding factors, postoperative radiotherapy reduced the adjusted hazard ratio (aHR) of 5-year OS to 0.64 (95% confidence interval [CI] 0.49–0.84) in those with < 18 lymph nodes (LNs) removed, but not in those with 19–24 LNs removed (aHR 0.78; 95% CI 0.73–1.13), and in those with ≥ 25 LNs removed (aHR 0.96; 95% CI 0.75–1.24). For 5-year DSS, similar effect was observed. The adjusted hazard ratio was 0.66 (95% confidence interval, 0.45–0.97) in those with < 18 LNs. The protective effect was not seen in those with 18–24 LNs (aHR 1.07; 95% CI 0.59–1.96), and in those with ≥ 25 LNs (aHR 1.12; 95% CI 0.81–1.56). Sensitivity testing also showed a robust protective effect of postoperative radiotherapy in patients with < 18 LNs removed. Conclusion Radiotherapy was associated with improved survival in pT1-2N1M0 oral and oropharyngeal cancer patients without adequate neck dissection.
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Affiliation(s)
- Ching-Chieh Yang
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Bor-Hwang Kang
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Pharmacy, Tajen University, Pingtung, Taiwan
| | - Wen-Shan Liu
- Department of Radiaton Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ching-Chih Lee
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. .,School of Medicine, National Defense Medical Center, Taipei, Taiwan. .,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
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Roy P, Mallick I, Arun I, Zameer L, Dey D, Singh A, Chatterjee S, Jain P, Manikantan K, Sharan R, Pattatheyil A. Nodal yield and topography of nodal metastases from oral cavity squamous cell carcinoma - An audit of 1004 cases undergoing primary surgical resection. Oral Oncol 2020; 113:105115. [PMID: 33341004 DOI: 10.1016/j.oraloncology.2020.105115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Nodal metastasis is an important prognostic factor in oral squamous cell carcinoma (OSCC). Detailed topographic study of metastasis can guide surgical and adjuvant radiation treatment protocols. METHODS Retrospective analysis of distribution of nodal spread was done by auditing pathology records of 1004 patients who underwent primary surgical management at our center. RESULTS The median nodal yield was 41 (range of 9-166) nodes, per patient. Metastasis was present in 42.9% patients, of which 52.3% demonstrated extranodal extension. Reclassification by AJCC8 criteria resulted in up-staging in 35.6% patients (pN1, pN2a, pN2b, pN2c, pN3a and pN3b in 13.1%, 3.7%, 6.9%, 0.9%, 0%, 18.1% respectively). Ipsilateral levels Ib and IIa were involved in a quarter of patients each, while IIb, IV and V were involved in < 4%, 3% and 1% of patients, respectively. Contralateral nodal metastasis was present in 5.4%. Skip metastases to level IV were 2.2% and 1.2% for tongue and gingivobuccal primaries. Tongue primaries had a lower likelihood of involving level Ib, but higher of level IIa and III, compared to gingivobuccal primaries, and a lower likelihood of extranodal extension. Primary site did not influence nodal metastasis to levels IIb, IV or V, but other factors like lymphovascular invasion, pT stage and margin status had an influence. CONCLUSION This large series with high nodal yield, shows low level of metastasis to level IIb, IV and V, which can help modify future guidelines for extent of surgery and avoid targeted adjuvant radiation to specific levels.
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Affiliation(s)
- Paromita Roy
- Oncopathology, Tata Medical Center, Kolkata, India.
| | | | - Indu Arun
- Oncopathology, Tata Medical Center, Kolkata, India
| | | | - Debdeep Dey
- Oncopathology, Tata Medical Center, Kolkata, India
| | - Angad Singh
- Oncopathology, Tata Medical Center, Kolkata, India
| | | | - Prateek Jain
- Head and Neck Surgery, Tata Medical Center, Kolkata, India
| | | | - Rajeev Sharan
- Head and Neck Surgery, Tata Medical Center, Kolkata, India
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31
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Topf MC, Philips R, Curry J, Magana LC, Tuluc M, Bar-Ad V, Keane W, Goldman RA, Luginbuhl A, Cognetti D. Impact of Lymph Node Yield in Patients Undergoing Total Laryngectomy and Neck Dissection. Ann Otol Rhinol Laryngol 2020; 130:591-601. [PMID: 33412910 DOI: 10.1177/0003489420964824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the impact of lymph node yield (LNY) in patients undergoing neck dissection at the time of total laryngectomy (TL). To determine the impact of radiation therapy (RT) on LNY. METHODS Retrospective review of LNY and clinical outcomes in 232 patients undergoing primary or salvage total laryngectomy (TL) with ND. RESULTS Preoperative RT significantly decreased mean LNY from 31.7 to 23.9 nodes (P < .001). In primary TL patients, age (P < .001) and positive margins (P = .044) were associated with decreased OS. In salvage TL patients, only positive margins was associated with poorer OS (P = .009). No LNY cutoff provided significant OS or DFS benefit. CONCLUSIONS Radiotherapy significantly reduces LNY in patients undergoing TL and ND. Within a single institution cohort, positive margins, but not LNY, is associated with survival in both primary and salvage TL patients.Level of Evidence: 4.
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Affiliation(s)
- Michael C Topf
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ramez Philips
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Joseph Curry
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Linda C Magana
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Madalina Tuluc
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Voichita Bar-Ad
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - William Keane
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Richard A Goldman
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Adam Luginbuhl
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - David Cognetti
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
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32
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Ferris RL, Flamand Y, Holsinger FC, Weinstein GS, Quon H, Mehra R, Garcia JJ, Hinni ML, Gross ND, Sturgis EM, Duvvuri U, Méndez E, Ridge JA, Magnuson JS, Higgins KA, Patel MR, Smith RB, Karakla DW, Kupferman ME, Malone JP, Judson BL, Richmon J, Boyle JO, Bayon R, O'Malley BW, Ozer E, Thomas GR, Koch WM, Bell RB, Saba NF, Li S, Sigurdson ER, Burtness B. A novel surgeon credentialing and quality assurance process using transoral surgery for oropharyngeal cancer in ECOG-ACRIN Cancer Research Group Trial E3311. Oral Oncol 2020; 110:104797. [PMID: 32679405 DOI: 10.1016/j.oraloncology.2020.104797] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/01/2020] [Accepted: 05/08/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Understanding the role of transoral surgery in oropharyngeal cancer (OPC) requires prospective, randomized multi-institutional data. Meticulous evaluation of surgeon expertise and surgical quality assurance (QA) will be critical to the validity of such trials. We describe a novel surgeon credentialing and QA process developed to support the ECOG-ACRIN Cancer Research Group E3311 (E3311) and report outcomes related to QA. PATIENTS AND METHODS E3311 was a phase II randomized clinical trial of transoral surgery followed by low- or standard-dose, risk-adjusted post-operative therapy with stage III-IVa (AJCC 7th edition) HPV-associated OPC. In order to be credentialed to accrue to this trial, surgeons were required to demonstrate active hospital credentials and technique-specific surgical expertise with ≥20 cases of transoral resection for OPC. In addition, 10 paired operative and surgical pathology reports from the preceding 24 months were reviewed by an expert panel. Ongoing QA required <10% rate of positive margins, low oropharyngeal bleeding rates, and accrual of at least one patient per 12 months. Otherwise surgeons were placed on hold and not permitted to accrue until re-credentialed using a new series of transoral resections. RESULTS 120 surgeons trained in transoral minimally invasive surgery applied for credentialing for E3311 and after peer-review, 87 (73%) were approved from 59 centers. During QA on E3311, positive final pathologic margins were reported in 19 (3.8%) patients. Grade III/IV and grade V oropharyngeal bleeding was reported in 29 (5.9%) and 1 (0.2%) of patients. CONCLUSIONS We provide proof of concept that a comprehensive credentialing process can support multicenter transoral head and neck surgical oncology trials, with low incidence of positive margins and *grade III/V oropharyngeal bleeding.
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Affiliation(s)
| | - Yael Flamand
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA, United States
| | | | | | - Harry Quon
- Johns Hopkins University, Baltimore, MD, United States
| | - Ranee Mehra
- University of Maryland, Baltimore, MD, United States
| | | | | | - Neil D Gross
- The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Erich M Sturgis
- The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | | | | | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, PA, United States
| | | | | | - Mihir R Patel
- Winship Cancer Institute at Emory University, Atlanta, GA, United States
| | | | | | - Michael E Kupferman
- The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - James P Malone
- UPMC Pinnacle Cancer Center, Harrisburg, PA, United States
| | - Benjamin L Judson
- Yale School of Medicine and Yale Cancer Center, New Haven, CT, United States
| | - Jeremy Richmon
- Massachusetts Eye and Ear, Harvard University, Boston, MA, United States
| | - Jay O Boyle
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | | | - Enver Ozer
- The Ohio State University, Columbus, OH, United States
| | - Giovana R Thomas
- University of Miami Leonard Miller School of Medicine, Miami, FL, United States
| | - Wayne M Koch
- Johns Hopkins University, Baltimore, MD, United States
| | - R Bryan Bell
- Providence Cancer Institute, Portland, OR, United States
| | - Nabil F Saba
- Winship Cancer Institute at Emory University, Atlanta, GA, United States
| | - Shuli Li
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA, United States
| | | | - Barbara Burtness
- Yale School of Medicine and Yale Cancer Center, New Haven, CT, United States
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León X, Neumann E, Gutiérrez A, García J, López M, Quer M. Weighted lymph node ratio: New tool in the assessment of postoperative staging of the neck dissection in HPV-negative head and neck squamous cell carcinoma patients. Head Neck 2020; 42:2912-2919. [PMID: 32588930 DOI: 10.1002/hed.26340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/25/2020] [Accepted: 05/30/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGOUND The objective of this study is to assess a new parameter, the weighted lymph node ratio (WLNR), which incorporates prognostic information regarding the number of metastatic nodes with extracapsular spread and the lymph node yield for pN0 patients to the lymph node ratio. METHODS We studied retrospectively 1118 patients with head and neck squamous cell carcinoma (HNSCC) treated with a neck dissection. RESULTS We obtained a classification with four categories based on the WLNR values. WLNR classification had a higher prognostic discrimination capacity and a more homogeneous distribution in the number of patients included in each of the categories than the pTNM classification. CONCLUSION The WLNR improved the predictive capacity of the eighth edition of the pTNM classification and it can be a useful tool in the assessment of the postoperative staging of the neck dissections in HNSCC patients.
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Affiliation(s)
- Xavier León
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Eduard Neumann
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alfons Gutiérrez
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jacinto García
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Montserrat López
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel Quer
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
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Holcomb AJ, Perryman M, Goodwin S, Penn J, Villwock MR, Bur AM, Shnayder Y, Tsue TT, Woodroof J, Kakarala K. Pathology protocol increases lymph node yield in neck dissection for oral cavity squamous cell carcinoma. Head Neck 2020; 42:2872-2879. [PMID: 32578921 DOI: 10.1002/hed.26343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/11/2020] [Accepted: 05/30/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Lymph node yield (LNY) is a proposed quality indicator in neck dissection for oral cavity squamous cell carcinoma (OCSCC). METHODS Retrospective series including 190 patients with OCSCC undergoing neck dissection between 2016 and 2018. A change in pathologic grossing protocol was initiated during the study period to assess residual adipose tissue. A generalized linear model was used to assess the impact of multiple variables on LNY. RESULTS Mean LNY was 28.59 (SD = 17.65). The protocol identified a mean of 10.32 lymph nodes per case. Multivariable analysis identified associations between LNY and use of the pathology protocol (P = .02), number of dissected lymph node levels (P < .001), presence of pathologic lymph nodes (P = .002), body mass index (P = .02), prior neck surgery (P = .001), and prior neck radiation (P = .001). CONCLUSIONS Assessment of residual adipose tissue within neck dissection specimens improves accuracy of LNY. LNY in neck dissection is influenced by multiple factors including methods of pathologic assessment.
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Affiliation(s)
- Andrew J Holcomb
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mollie Perryman
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sara Goodwin
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joseph Penn
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mark R Villwock
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrés M Bur
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Yelizaveta Shnayder
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Terance T Tsue
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Janet Woodroof
- Department of Pathology and Lab Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kiran Kakarala
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
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Nurimba M, Hines W, Sinha U, Mathew A, Kokot N, Swanson M. Evaluation of lymph node ratio and lymph node yield as prognosticators of locoregional recurrence in p16-associated oropharyngeal squamous cell carcinoma. Head Neck 2020; 42:2811-2820. [PMID: 32542889 DOI: 10.1002/hed.26324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/31/2020] [Accepted: 05/27/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The prognostic value of lymph node yield (LNY) and lymph node ratio (LNR), or the ratio of number of metastatic LNs to total number dissected, has not been well established in p16-associated oropharyngeal squamous cell carcinoma (OPSCC). METHODS This retrospective cohort study evaluated locoregional disease-free survival (LRDFS) in 82 patients with p16+ OPSCC who underwent neck dissection at a single institution from 2009 to 2017. LNR and LNY cutoffs were estimated using time-dependent receiver operator characteristic (ROC) curves. Prognostic significance of these cutoffs was compared with Eighth Edition AJCC Nodal Staging. RESULTS An increased LNR ≥ 0.129 was associated with worse 2-year LRDFS (66.9% vs 96.8%, P = .005). LNY was not significantly associated with LRDFS (P = .304). An LNR-based risk model was a better prognosticator than Eighth Edition AJCC Nodal Staging (Harrell's C, 0.9065 vs 0.7668). CONCLUSIONS LNR has good prognostic utility in predicting LRDFS in p16+ OPSCC, but further evaluation of this measure is warranted.
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Affiliation(s)
- Margaret Nurimba
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - William Hines
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Uttam Sinha
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Anna Mathew
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Niels Kokot
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Mark Swanson
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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36
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Iocca O, Di Maio P, De Virgilio A, Pellini R, Golusiński P, Petruzzi G, Zocchi J, Pirola F, Janczak R, Golusiński W, Spriano G, Weinstein GS, Rassekh CH. Lymph node yield and lymph node ratio in oral cavity and oropharyngeal carcinoma: Preliminary results from a prospective, multicenter, international cohort. Oral Oncol 2020; 107:104740. [PMID: 32380357 DOI: 10.1016/j.oraloncology.2020.104740] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Recently, Lymph Node Yield (LNY) and Lymph Node Ratio (LNR) have emerged as prognostic indicators in head and neck cancer. However, there is a lack of data regarding the LNY and LNR values in the specific neck levels dissected and regarding the factors that influence these values. MATERIALS AND METHODS Preliminary results of the NCT03534778 trial are reported. LNY and LNR values were estimated for 100 patients with oral or oropharynx carcinoma, from November 1, 2018 to September 30, 2019. RESULTS Overall, the mean number of lymph nodes retrieved was 34.4 (95% confidence interval [CI] 31.6-37.3). LNY means and CI per single neck level were as follows: level I 5.5 lymph nodes harvested (95% CI 3.5-7.5), level II 15.4 (95% CI 10.6-20.2), level III 8.0 (95% CI 4.6-11.3), level IV 6.3 (95% CI 3.4-9.15), level V 6.3 (95% CI 3.6-9.0). cN+ patients had a higher number of lymph nodes retrieved, odds ratio (OR) 1.2 (95% CI 1.05-1.36). Smokers had less lymph nodes harvested, OR 0.78 (95% CI, 0.71-0.87). Mean LNR was 0.063 (95% CI 0.047-0.078). A multiple regression analysis showed that anatomic site, pN, smoking status and LNY statistically significantly predicted the LNR (p < 0.05) CONCLUSIONS: The LNY and LNR values are influenced by various demographic and pathological characteristics of the patient, such as the number of dissected levels, primary site, cN positivity, and smoking status.
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Affiliation(s)
- Oreste Iocca
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, MI, Italy.
| | - Pasquale Di Maio
- Giovanni Borea Civil Hospital, Department of Otolaryngology-Head and Neck Surgery, Sanremo, Italy
| | - Armando De Virgilio
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Raul Pellini
- Department of Otolaryngology- Head Neck Surgery, Regina Elena National Cancer Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Paweł Golusiński
- Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora, Zielona Gora, Poland; Department of Biology and Environmental Studies, Poznan University of Medical Sciences, Poznan, Poland
| | - Gerardo Petruzzi
- Department of Otolaryngology- Head Neck Surgery, Regina Elena National Cancer Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Jacopo Zocchi
- Department of Otolaryngology- Head Neck Surgery, Regina Elena National Cancer Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Francesca Pirola
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Radoslaw Janczak
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Poznan, Poland
| | - Wojciech Golusiński
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Poznan, Poland
| | - Giuseppe Spriano
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Gregory S Weinstein
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Christopher H Rassekh
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
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Rozenblat T, Hirsch D, Robenshtok E, Grozinsky-Glasberg S, Gross DJ, Mazeh H, Benbassat C, Twito O, Levy S, Mizrachi A, Shpitzer T, Bachar G. The prognostic value of lymph node ratio in Medullary thyroid carcinoma: A multi-center study. Eur J Surg Oncol 2020; 46:2023-2028. [PMID: 32389525 DOI: 10.1016/j.ejso.2020.04.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/12/2020] [Accepted: 04/10/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The lymph node ratio (LNR), which represents the proportion of metastatic lymph nodes resected, has been found to be a prognostic variable in several cancers, but data for Medullary thyroid carcinoma (MTC) are sparse. The aim of this study was to determine the value of the LNR in predicting outcome in patients with MTC. MATERIALS AND METHODS A retrospective multicenter study design of 107 patients with MTC who underwent total thyroidectomy with neck dissection between 1984 and 2016. The association of LNR with patient and tumor characteristics and prognostic factors was evaluated. RESULTS Study population consisted of 53.3% female, mean age at diagnosis was 50.3 ± 18.4 years; 16.8% had inherited MTC. LNR was positively correlated with tumor size (p = 0.018) and inversely correlated with age at diagnosis (p = 0.024). A higher LNR was associated with extrathyroidal extension (p < 0.001), multifocality (p = 0.001), bilateral tumor (p = 0.002), distant metastases (p < 0.001), and tumor recurrence (OR = 14.7, p < 0.001). LNR was also correlated to postoperative calcitonin levels (p < 0.001) and carcinoembryonic antigen (p = 0.011). LNR >0.1 was associated with shorter disease-specific survival in patients at risk: tumor larger than 20 mm at diagnosis (p = 0.013), sporadic MTC (p = 0.01), and age above 40 years at diagnosis (p = 0.004). Cox multivariate survival analysis revealed LNR as the only significant independent factor for disease free survival (p = 0.005). CONCLUSIONS This study showed that LNR correlates well with patient and tumor characteristics and prognostic variables. We suggest that LNR should be considered an important parameter for predicting outcome in MTC.
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Affiliation(s)
- Tal Rozenblat
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dania Hirsch
- Institute of Endocrinology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eyal Robenshtok
- Institute of Endocrinology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Endocrinology & Metabolism Service, Department of Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - David J Gross
- Neuroendocrine Tumor Unit, Endocrinology & Metabolism Service, Department of Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Haggi Mazeh
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Carlos Benbassat
- Endocrine Institute, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Orit Twito
- Institute of Endocrinology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Sigal Levy
- Statistics Education Unit, The Academic College of Tel Aviv-Yaffo, Israel.
| | - Aviram Mizrachi
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Thomas Shpitzer
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gideon Bachar
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Zenga J, Divi V, Stadler M, Massey B, Campbell B, Shukla M, Awan M, Schultz CJ, Shreenivas A, Wong S, Jackson RS, Pipkorn P. Lymph node yield, depth of invasion, and survival in node-negative oral cavity cancer. Oral Oncol 2019; 98:125-131. [DOI: 10.1016/j.oraloncology.2019.09.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 12/17/2022]
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Noel JE, Orloff LA. Recognizing Persistent Disease in Well-Differentiated Thyroid Cancer and Association with Lymph Node Yield and Ratio. Otolaryngol Head Neck Surg 2019; 162:50-55. [PMID: 31661359 DOI: 10.1177/0194599819886123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To establish the association between lymph node yield and ratio in neck dissection for well-differentiated thyroid cancer and risk for persistent postoperative disease. STUDY DESIGN Retrospective cohort study of patients undergoing lymphadenectomy for thyroid carcinoma. SETTING Tertiary referral center. SUBJECTS AND METHODS Included patients underwent central and/or lateral neck dissection for papillary thyroid carcinoma at our institution between 1994 and 2015. They were divided into a persistent disease group with biochemical and structural disease (49 patients) and a disease-free group with no disease after a minimum 2 years of follow-up (175 patients). Demographic characteristics, adjuvant therapy, tumor, and lymph node features were compared. RESULTS There were no significant differences in demographic characteristics between the groups. The mean nodal yield of patients with central and lateral neck persistence was significantly lower than that of patients remaining disease free (4.8 vs. 11.9: odds ratio [OR] 0.69; 95% CI, 0.59 to 0.8; P < .001; 14.8 vs. 31.0: OR, 0.89; 95% CI, 0.84-0.94; P < .001, respectively). Nodal ratio was higher in patients with persistence in the central and lateral neck (74.2% vs 29.4%: OR, 1.06; 95% CI, 1.04-1.08; P < .001; 54.2% vs 19.8%: OR, 1.08; 95% CI, 1.04-1.12; P < .001, respectively). CONCLUSIONS Lower lymph node yield and higher node ratio from cervical lymph node dissections are associated with persistent disease and have potential applications in surgical adequacy.
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Affiliation(s)
- Julia E Noel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Lisa A Orloff
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
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40
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Bao X, Chen F, Qiu Y, Shi B, Lin L, He B. Log Odds of Positive Lymph Nodes is Not Superior to the Number of Positive Lymph Nodes in Predicting Overall Survival in Patients With Oral Squamous Cell Carcinomas. J Oral Maxillofac Surg 2019; 78:305-312. [PMID: 31705864 DOI: 10.1016/j.joms.2019.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/26/2019] [Accepted: 09/24/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE It is unclear whether the log odds of positive lymph nodes (LODDS) outperforms the number of positive lymph nodes (LN+) in predicting the overall survival (OS) of oral squamous cell carcinoma (OSCC) patients. The specific aim of this study was to compare the prognostic predictive performance of LN+ with LODDS in OSCC patients. MATERIALS AND METHODS This prospective cohort study was conducted in Fujian, China, from December 2005 to January 2017. Patients' characteristics and clinicopathologic data were obtained through medical records, and follow-up data were obtained by telephone interviews. Cox proportional hazards models were used to evaluate the association between LN+ or LODDS and OS in OSCC. Finally, the Harrell concordance index, Akaike information criterion, and area under the receiver operating characteristic curve were adopted as criteria for assessing the predictive performance of lymph node models. RESULTS For all 706 patients, the 5-year survival rate was 65.69% (95% confidence interval, 0.61 to 0.70) and the mean age at diagnosis was 57.32 ± 11.80 years. Of the patients, 456 were men and 250 were women (ratio of 1.82:1). LN+ and LODDS were significantly associated with a poor prognosis of OSCC patients (all P values for trend < .001). Furthermore, the prognostic value of LODDS was not better than that of LN+. An interesting finding was that there was a J-shaped relationship between the number of negative lymph nodes and OS. The hazard ratio was reduced with each additional negative lymph node dissected up to 24 negative lymph nodes, with no improvement in prognosis beyond this number. Moreover, when the number of negative lymph nodes was greater than 40, the negative lymph nodes suggested a worse prognosis for OSCC patients. CONCLUSIONS Our study suggests that the discriminatory capability of LODDS was not superior to that of LN+. An interesting finding was that, when the number of negative lymph nodes was greater than 40, the predictive power of LODDS was reduced tremendously.
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Affiliation(s)
- Xiaodan Bao
- Master Degree Candidate, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Fa Chen
- Lecturer, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Yu Qiu
- Physician, Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Bin Shi
- Physician, Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lisong Lin
- Physician, Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Baochang He
- Associate Professor, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China.
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41
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Chipollini J, Azizi M, Lo Vullo S, Mariani L, Zhu Y, Ye DW, Ornellas AA, Watkin N, Ager M, Hakenberg O, Heidenreich A, Raggi D, Catanzaro M, Ornellas P, Salvioni R, Cheriyan SK, Necchi A, Spiess PE. Identifying an optimal lymph node yield for penile squamous cell carcinoma: prognostic impact of surgical dissection. BJU Int 2019; 125:82-88. [PMID: 31356716 DOI: 10.1111/bju.14883] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the prognostic impact of lymph node yield (LNY) on survival outcomes for penile squamous cell carcinoma (SCC). PATIENTS AND METHODS In all, 532 patients who underwent inguinal LN dissection (ILND) across tertiary referral centres from Europe, China, Brazil and North America were retrospectively evaluated. From this cohort, 198 patients received pelvic LND (PLND).We identified threshold values for ILND and PLND using receiver operating characteristic curves. We tested prognostic value of LNY for recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) using the Kaplan-Meir method and Cox proportional hazard regression models. RESULTS The median (interquartile [IQR]) age was 59 (49-68) years and the median (IQR) follow-up after ILND was 28 (12-68.2) months. Overall, 85% of the patients had bilateral dissections. The median (IQR) number of inguinal LNs removed was 15 (10-22). Of those receiving PLND, The median (IQR) number of LNs was 13 (8-19). A LNY of ≥15 was used for dichotomisation of ILND patients, and a LNY of ≥9 was used in the PLND cohort. Patients with a LNY ≥15 had significantly better 5-year OS vs patients with a LNY <15 (70.1% vs 58.7%). On multivariable analyses, a LNY ≥15 was a predictor of OS (hazard ratio [HR] 0.68, P = 0.029). For cN0 patients, a LNY ≥15 was an independent predictor of RFS (HR 0.52, P = 0.043) and OS (HR 0.53, P = 0.021). In the PLND cohort, a LNY ≥9 was a predictor of RFS (HR 0.53, P = 0.032). CONCLUSIONS Using one of the largest LND datasets to date, we found LNY to be a significant predictor of outcomes after lymphatic staging for penile SCC. Prospective validation is warranted.
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Affiliation(s)
- Juan Chipollini
- The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Mounsif Azizi
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Luigi Mariani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Yao Zhu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ding W Ye
- Fudan University Shanghai Cancer Center, Shanghai, China
| | | | - Nick Watkin
- NHS Foundation Trust, St. George's University Hospitals, London, UK
| | - Michael Ager
- NHS Foundation Trust, St. George's University Hospitals, London, UK
| | | | | | - Daniele Raggi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Mario Catanzaro
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paulo Ornellas
- Hospital Mário Kröeff and Brazilian Cancer Institute, Rio de Janeiro, Brazil
| | | | - Salim K Cheriyan
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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42
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Lymph node yield and lymph node density for elective level II-IV neck dissections in laryngeal squamous cell carcinoma patients. Eur Arch Otorhinolaryngol 2019; 276:2923-2927. [PMID: 31317320 DOI: 10.1007/s00405-019-05560-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/11/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE To determine the minimum lymph node yield (LNY) in patients with laryngeal squamous cell carcinoma (LSCCs). METHODS This retrospective study was performed in a tertiary care hospital setting and included 42 LSCC patients aged 39-81 years (females, n = 2; males, n = 40) who underwent a total or partial laryngectomy and elective bilateral level II-IV neck dissections (unilateral neck dissections: n = 84). RESULTS The average LNY in the unilateral level II-IV lymph node dissections was 25.9 ± 10, and the average metastatic LNY was 0.9 ± 1.9. The unilateral neck dissections were grouped according to the number of lymph nodes. There was no significant difference between the groups in terms of the metastatic LNY (p = 0.5). The metastatic lymph node density (LND) (metastatic lymph node yield/LNY) was 0.043 for unilateral neck level II-IV neck dissections. A Cox regression analysis revealed no significant relationship between survival and the LNY and LND in bilateral neck dissections (p = 0.4 and p = 0.8, respectively). CONCLUSIONS The results revealed no minimum number of lymph nodes that could reliably detect metastatic lymph nodes in LSCC patients.
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43
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Is Lymph Node Ratio a Prognostic Factor for Patients With Oral Squamous Cell Carcinoma? J Oral Maxillofac Surg 2019; 77:1510-1519. [DOI: 10.1016/j.joms.2019.01.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/22/2018] [Accepted: 01/20/2019] [Indexed: 01/25/2023]
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44
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Oliver JR, Wu SP, Chang CM, Roden DF, Wang B, Hu KS, Schreiber D, Givi B. Survival of oral tongue squamous cell carcinoma in young adults. Head Neck 2019; 41:2960-2968. [DOI: 10.1002/hed.25772] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/02/2019] [Accepted: 04/02/2019] [Indexed: 01/09/2023] Open
Affiliation(s)
- Jamie R. Oliver
- Department of Otolaryngology, NYU School of Medicine New York New York
| | - S. Peter Wu
- Department of Radiation OncologyNYU Langone Health New York New York
| | - Clifford M. Chang
- Department of Otolaryngology, NYU School of Medicine New York New York
| | - Dylan F. Roden
- Department of OtolaryngologyThomas Jefferson University Philadelphia Pennsylvania
| | - Binhuan Wang
- Department of Population HealthNYU Langone Health New York New York
| | - Kenneth S. Hu
- Department of Radiation OncologyNYU Langone Health New York New York
| | - David Schreiber
- Department of Radiation OncologySUNY Downstate Medical Center Brooklyn New York
| | - Babak Givi
- Department of OtolaryngologyNYU Langone Health New York New York
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45
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de Kort WWB, Maas SLN, Van Es RJJ, Willems SM. Prognostic value of the nodal yield in head and neck squamous cell carcinoma: A systematic review. Head Neck 2019; 41:2801-2810. [PMID: 30969454 PMCID: PMC6767522 DOI: 10.1002/hed.25764] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/10/2019] [Accepted: 03/25/2019] [Indexed: 12/17/2022] Open
Abstract
Objective Literature analysis on the prognostic factor of the nodal yield (NY) in neck dissections (NDs), which in general surgical oncology is a strong prognosticator and quality‐of‐care marker. Methods We performed a systematic review of all PubMed and Embase publications until June 30, 2018 screening for data on NY as prognosticator and overall survival (OS) as outcome in patients with head and neck squamous cell carcinoma (HNSCC). Risk for bias was asserted by application of the Quality In Prognosis Studies tool. Results Of the 823 screened publications, 15 were included in this analysis. Five out of seven that compared NY ≥18 vs <18 as prognosticator, showed significantly improved survival if NY ≥18. Six studies used other cutoffs and three reported improved survival with each additionally harvested lymph node. Conclusion Increased NY in ND specimen for HNSCC, most commonly described as ≥18 lymph nodes, is associated with improved OS and could be used as a prognosticator and quality‐of‐care marker.
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Affiliation(s)
- Willem W B de Kort
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sybren L N Maas
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J J Van Es
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
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46
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Reyes C, Rios J, Groves M, Solares CA, Jackson L, Byrd JK. Radiation Therapy Impact on Lymph Node Yield in Patients With Laryngeal Squamous Cell Carcinoma. EAR, NOSE & THROAT JOURNAL 2019; 98:283-286. [PMID: 30961371 DOI: 10.1177/0145561319839790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A lymph node yield (LNY) over 20 is considered a quality metric for lateral neck dissection to ensure an oncologic representative sample. Anecdotally, however, LNY in patients undergoing neck dissection after radiation therapy (RT) is lower due to atrophy and fibrosis. OBJECTIVE To determine whether preoperative RT decreases LNY in patients with laryngeal cancers undergoing surgery. METHODS Medical record database was queried for patients presenting between 2006 and 2015 with laryngeal cancer. Tabulation was made for location (glottic/supraglottic), stage, and side for the total number of lymph nodes between primary surgery and RT (salvage surgery) groups. Descriptive analysis and a paired Student t test were used for statistical analysis. RESULTS Fifty-nine patients were included in the study for a total of 98 neck dissections. Twenty-six (44%) patients had primary surgery, and 33 (56%) patients had salvage surgery. The mean left and right total LNY in the salvage surgery group was 27.6 and 29.5, respectively, and 32.2 and 33.7 for the primary surgery group. A difference of 4.5 (left) and 4.3 (right) in LNY between the salvage surgery and primary surgery group was found. A Student t test showed no statistically significant difference in LNY between both groups when analyzed per site (glottic and supraglottic), side, and stage (III-IV). CONCLUSION Although patients with prior RT had a lower mean of LNY, our results did not demonstrate a statistically significant difference. Further studies with a larger number of patients are recommended.
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Affiliation(s)
- Camilo Reyes
- 1 Department of Otolaryngology-Head and Neck Surgery, Augusta University, Augusta, GA, USA
| | - Julian Rios
- 1 Department of Otolaryngology-Head and Neck Surgery, Augusta University, Augusta, GA, USA
| | - Michael Groves
- 1 Department of Otolaryngology-Head and Neck Surgery, Augusta University, Augusta, GA, USA
| | - C Arturo Solares
- 2 Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA, USA
| | - Lana Jackson
- 3 Department of Otolaryngology-Head and Neck Surgery, University of Mississippi, Jackson, MS, USA
| | - J Kenneth Byrd
- 1 Department of Otolaryngology-Head and Neck Surgery, Augusta University, Augusta, GA, USA
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47
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Elhusseiny KM, Abd-Elhay FAE, Kamel MG, Abd El Hamid Hassan HH, El Tanany HHM, Hieu TH, Tieu TM, Low SK, Hou V, Dibas M, Huy NT. Examined and positive lymph nodes counts and lymph nodes ratio are associated with survival in major salivary gland cancer. Head Neck 2019; 41:2625-2635. [PMID: 30905082 DOI: 10.1002/hed.25742] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/22/2018] [Accepted: 03/05/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We aimed to investigate the prognostic role of examined (dissected) lymph nodes (ELNs), negative LNs (NLNs), and positive (metastatic) LNs (PLNs) counts and LN ratio (LNR = PLNs/ELNs×100) in patients with major salivary gland cancer (SGC). METHODS Data were retrieved for major SGC patients diagnosed between 1988 and 2011 from Surveillance, Epidemiology, and End Results program. RESULTS We have included 5446 patients with major SGC. Most patients had parotid gland cancer (84.61%). Patients having >18 ELNs, >4 PLNs, and >33.33% LNR were associated with a worse survival. Moreover, older age, male patients, grade IV, distant stage, unmarried patients, submandibular gland cancer, and received chemotherapy but not received surgery were significantly associated with a worse survival. CONCLUSIONS We demonstrated that patients with >18 ELNs and >4 PLNs counts, and >33.33% LNR were high-risk group patients. We strongly suggest adding the ELNs and PLNs counts and/or LNR into the current staging system.
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Affiliation(s)
- Khaled Mosaad Elhusseiny
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt.,Online Research Club (http://www.onlineresearchclub.org/
| | | | - Mohamed Gomaa Kamel
- Online Research Club (http://www.onlineresearchclub.org/.,Faculty of Medicine, Minia University, Minia, Egypt
| | - Heba Hassan Abd El Hamid Hassan
- Online Research Club (http://www.onlineresearchclub.org/.,Faculty of Pharmacy, Modern University for Technology and Information, Cairo, Egypt
| | | | - Truong Hong Hieu
- Online Research Club (http://www.onlineresearchclub.org/.,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thuan Minh Tieu
- Online Research Club (http://www.onlineresearchclub.org/.,McMaster University, Hamilton, Ontario, Canada
| | - Soon Khai Low
- Online Research Club (http://www.onlineresearchclub.org/.,School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Selangor, Malaysia
| | - Vincent Hou
- Online Research Club (http://www.onlineresearchclub.org/.,McMaster University, Hamilton, Ontario, Canada
| | - Mahmoud Dibas
- Online Research Club (http://www.onlineresearchclub.org/.,Sulaiman Al Rajhi Colleges, Al Bukayriya, Saudi Arabia
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group, Ton Duc Thang University, Ho Chi Minh City, 70000, Vietnam.,Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, 70000, Vietnam.,Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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48
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Iocca O, Farcomeni A, De Virgilio A, Di Maio P, Golusinski P, Malvezzi L, Pellini R, Golusinski W, Rassekh CH, Spriano G. Prognostic significance of lymph node yield and lymph node ratio in patients affected by squamous cell carcinoma of the oral cavity and oropharynx: Study protocol for a prospective, multicenter, observational study. Contemp Clin Trials Commun 2019; 14:100324. [PMID: 30723839 PMCID: PMC6353728 DOI: 10.1016/j.conctc.2019.100324] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 11/30/2022] Open
Abstract
Background Lymph node involvement is a fundamental prognostic factor in head and neck squamous cell carcinoma (SCC). Lymph node yield (LNY), which is the number of lymph nodes retrieved after neck dissection, and lymph node ratio (LNR), which is the ratio of positive lymph nodes out of the total removed, are measurable indicators that may have the potential to be used as prognostic factors. The present study is designed to define the exact role of LNY and LNR regarding the overall and specific survival of patients affected by oral cavity and oropharyngeal SCC. It has been registered on clinicaltrials.gov database (NCT03534778). Methods This is a multicenter study involving tertiary care referral centers in Europe and North America. Patients affected by oral cavity, HPV+ and HPV- oropharyngeal SCC undergoing neck dissection will be consecutively enrolled and followed-up for up to 5 years. Patients and disease characteristic will be properly recorded and centrally analyzed. The primary end-point is to define reliable cut off-values for LNY and LNR which may serve as prognosticators of survival. This will be achieved through the use of ROC curves. Secondary outcomes will be the Overall survival (OS), Disease Specific Survival (DSS), and Progression Free Survival Hazard Ratios (HR) at 2-, 3- and 5 years, which will be evaluated through the Kaplan-Meier method and the difference in survival attested by the log-rank test. Univariate and multivariate analysis will be performed to understand the association of various outcomes with LNY and LNR.
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Affiliation(s)
- Oreste Iocca
- Department of Otolaryngology- Head and Neck Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
| | - Alessio Farcomeni
- Department of Public Health and Infectious Diseases Sapienza - University of Rome, Rome, Italy
| | - Armando De Virgilio
- Department of Otolaryngology- Head and Neck Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
| | - Pasquale Di Maio
- Section of Otolaryngology and Neck Surgery, Dept. of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Paweł Golusinski
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Poznan, Poland
| | - Luca Malvezzi
- Department of Otolaryngology- Head and Neck Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
| | - Raul Pellini
- Department of Otolaryngology- Head and Neck Surgery, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Wojciech Golusinski
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Poznan, Poland
| | - Christopher H Rassekh
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Giuseppe Spriano
- Department of Otolaryngology- Head and Neck Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
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49
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Sukato DC, Ballard DP, Abramowitz JM, Rosenfeld RM, Mlot S. Robotic versus conventional neck dissection: A systematic review and meta-analysis. Laryngoscope 2018; 129:1587-1596. [DOI: 10.1002/lary.27533] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Daniel C. Sukato
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Daniel P. Ballard
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Jason M. Abramowitz
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Richard M. Rosenfeld
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Stefan Mlot
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
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50
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Soodana-Prakash N, Koru-Sengul T, Miao F, Lopategui DM, Savio LF, Moore KJ, Johnson TA, Alameddine M, Barboza MP, Parekh DJ, Punnen S, Gonzalgo ML, Ritch CR. Lymph node yield as a predictor of overall survival following inguinal lymphadenectomy for penile cancer. Urol Oncol 2018; 36:471.e19-471.e27. [DOI: 10.1016/j.urolonc.2018.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/27/2018] [Accepted: 07/17/2018] [Indexed: 12/23/2022]
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