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Li R, Wang X. Number of positive lymph nodes and lymph node ratio predict recurrence and survival in hypopharyngeal cancer based on SEER database and validation of real-world data. Eur Arch Otorhinolaryngol 2024; 281:4921-4936. [PMID: 38709323 DOI: 10.1007/s00405-024-08697-8] [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: 02/05/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE This study investigated the impacts of the number of positive lymph nodes (NPLN) and lymph node ratio (LN ratio) for patients with hypopharyngeal squamous cell carcinoma (HPSCC) based on SEER database, which were validated in the real-world data of China. METHODS A total of 520 patients from SEER database were analyzed. Then 195 patients with pathologically stage III or IV HPSCC in our center were retrospectively studied. RESULTS In the SEER database, NPLN ≥ 3 was found in 36.9% of patients. Multivariate analysis revealed that LN ratio ≥ 0.138 was significant with poorer overall survival (OS) (hazard ratio [HR] = 1.525, p = 0.001) and cancer-specific survival (CSS) (HR = 1.697, p < 0.001), so was the NPLN ≥ 3 (HR = 1.388, p = 0.013; HR = 1.479, p = 0.008). Patients with NPLN ≥ 3 were found in 103 (52.8%) in our center. Multivariate analysis confirmed a significant association regarding OS (p = 0.005) or CSS (p = 0.003) between patients with LN ratio ≥ 0.138 or not. In addition, disease recurrence rate differed significantly between the patients with NPLN ≥ 3 (27.2%) and NPLN < 3 (14.1%, p = 0.026). Moreover, postoperative chemoradiotherapy (CCRT) was significantly associated with better prognosis in patients with NPLN ≥ 3. CONCLUSION In the SEER database, NPLN ≥ 3 and LN ratio ≥ 0.138 were independent poor prognostic factors for patients with HPSCC. Whereas identifying worldwide cut-off values for LN ratio is difficult and surgeon-dependent. In our cohort, adjuvant CCRT was beneficial for OS in patients with NPLN ≥ 3.
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Affiliation(s)
- Ruichen Li
- Department of Radiation Oncology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Xuhui, Shanghai, 200031, People's Republic of China
| | - Xiaoshen Wang
- Department of Radiation Oncology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Xuhui, Shanghai, 200031, People's Republic of China.
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Faisal M, Le NS, Grasl S, Pammer J, Janik S, Heiduschka G, Schratter-Sehn AU, Franz P, Königswieser M, Grasl MC, Erovic BM. Survival Outcome in True Carcinoma of Unknown Primary (tCUP) with p16 + Cervical Metastasis. Int Arch Otorhinolaryngol 2023; 27:e687-e693. [PMID: 37876688 PMCID: PMC10593513 DOI: 10.1055/s-0042-1759575] [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: 09/18/2021] [Accepted: 08/22/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Age and lymph node ratio have been attributed as independent predictors for survival and recurrence in carcinoma of unknown primary (CUP). Objective The purpose of this study was to analyze the prognostic value of p16 overexpression for CUP in the absence of true primary (TP). Methods The study involved 43 patients who underwent therapeutic lymph node dissection (LND) from 2000 to 2015 after all the diagnostic work up for CUP. Immunohistochemistry for p16 overexpression was performed. Cox proportional hazard regression analysis was used to analyze the prognostic impact on 5-year overall survival (OS) and recurrence-free survival (RFS). Results The male-to-female ratio was 5.1:1, with a median age of 62 years. The clinicopathological data, except for p16 overexpression, did not differ significantly in terms of 5-year OS and RFS. The Cox regression analysis proposed p16 positivity to be an independent prognosticator of regional recurrence-free survival (RRFS) (hazard ratio [HR] 6.180, p = 0.21). The median time to recurrence and death were 10 and 25 months, respectively. Conclusion Cervical metastasis with p16 overexpression is a significant prognostic factor of improved RFS after surgery in CUP. The prognostic significance of lymph node p16 positivity should be further studied.
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Affiliation(s)
- Muhammad Faisal
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
- Institute of Head and Neck Diseases, Evangelical Hospital, Vienna, Austria
| | - Nguyen-Son Le
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes Pammer
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - Stefan Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Gregor Heiduschka
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Peter Franz
- Department of Otorhinolaryngology, Head and Neck Surgery, Rudolfstiftung Hospital, Vienna, Austria
| | - Meinhard Königswieser
- Department of Otorhinolaryngology, Head and Neck Surgery, Rudolfstiftung Hospital, Vienna, Austria
| | - Matthaeus Ch. Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Boban M. Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, Vienna, Austria
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Li F, Huang Q, Hsueh C, Huang H, Zhu Y, Gong H, Tao L, Zhou L, Zhang M. A Survival Nomogram Containing Lymph Node Ratio for Hypopharyngeal Carcinoma Patients After Neck Dissection. Otolaryngol Head Neck Surg 2023; 168:1097-1106. [PMID: 36939525 DOI: 10.1002/ohn.187] [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: 08/13/2022] [Revised: 09/27/2022] [Accepted: 10/09/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The purpose of our study is to establish a survival nomogram based on lymph node ratio (LNR) in hypopharyngeal carcinoma. STUDY DESIGN Retrospective cohort study. SETTING Hypopharyngeal squamous cell carcinoma (HPSCC) is prone to regional metastasis. Emerging evidence has shown that LNR is a promising prognostic factor in HPSCC. METHODS From January 2004 to January 2018, 411 HPSCC patients who underwent neck dissection at our institution were retrospectively studied. The enrolled patients were divided into training and validation cohorts at a ratio of 7:3. A survival nomogram was finally built based on factors screened from multivariate analysis using the bidirectional stepwise method. RESULTS LNR was superior to other nodal classifications for survival prediction and was used to establish the R classification. A nomogram was developed using R classification (p < .001), pT classification (p < .001), tumor invasive depth (p < .001), and internal jugular vein adhesion (p = .001). The C-indexes were 0.712 and 0.703 in the training and validation dataset. The 36- and 60-month AUCs were 0.767 and 0.766 in the training dataset and 0.713 and 0.757 in the validation dataset, respectively. The calibration curves showed relatively good agreement between the predicted and actual probability. CONCLUSION Based on the LNR, we developed a survival nomogram for HPSCC after neck dissection, which will be a practical tool to discriminate patients with different survival risks.
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Affiliation(s)
- Feiran Li
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Qiang Huang
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Chiyao Hsueh
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Huiying Huang
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yi Zhu
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Hongli Gong
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Lei Tao
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Liang Zhou
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Ming Zhang
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
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Nishimura A, Yokota T, Hamauchi S, Onozawa Y, Notsu A, Sato F, Kawakami T, Ogawa H, Onoe T, Mukaigawa T. Prognostic impact of the number of metastatic lymph nodes after surgery in locally advanced hypopharyngeal cancer. BMC Cancer 2022; 22:1101. [PMID: 36303119 PMCID: PMC9615187 DOI: 10.1186/s12885-022-10172-8] [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: 07/05/2022] [Accepted: 10/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background Postoperative chemoradiotherapy (CRT) is a standard therapy for patients with high-risk factors for head and neck squamous cell carcinoma, including positive margin and extra-nodal extension (ENE). However, the prognostic impact of the number of pathological metastatic lymph nodes (pLNs) in hypopharyngeal carcinoma (HPC) is unclear. Thus, this study aimed to investigate postoperative prognostic factors for locally advanced hypopharyngeal squamous cell carcinoma (LA-HPSCC) with a focus on the number of pLNs. Methods We retrospectively analyzed medical records of 99 consecutive patients with LA-HPSCC who underwent total pharyngo-laryngo-esophagectomy (TPLE) and bilateral neck dissection (ND) between December 2002 and May 2019. Results The median follow-up time for all censored patients was 63.2 months. The median overall survival (OS) was 101.0 months (95% confidence interval [CI] 48.1–134.9). patients had pLNs ≥ 3. Forty-six (45.5%) patients were diagnosed with ENE. Twenty (20.2%) patients received postoperative CRT. The multivariate analysis revealed that pLNs ≥ 3 (median OS: 163.2 vs. 31.8 months, hazard ratio [HR] 2.39, 95% CI 1.16–4.94, p < 0.01) and ENE (median OS: 161.0 vs. 26.3 months, HR 4.60, 95% CI 2.26–9.36, p < 0.01) were significantly associated with poor prognosis and that postoperative CRT (HR 0.34, 95% CI 0.16–0.72, p < 0.01) was significantly associated with better prognosis. The cumulative incidence of distant metastasis was higher in patients with pLNs ≥ 3 than in those with pLNs < 3 (p < 0.01). Conclusion pLNs ≥ 3 and ENE were significant poor prognostic factors for patients with LA-HPSCC who underwent TPLE and bilateral ND.
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Affiliation(s)
- Ari Nishimura
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007, Shizuoka, Japan
| | - Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007, Shizuoka, Japan.
| | - Satoshi Hamauchi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007, Shizuoka, Japan
| | - Yusuke Onozawa
- Division of Medical Oncology, Shizuoka Cancer Center, 1007, Shizuoka, Japan
| | - Akifumi Notsu
- Department of Biostatistics, Clinical Research Center, Shizuoka Cancer Center, 1007, Shizuoka, Japan
| | - Fuyuki Sato
- Division of Pathology, Shizuoka Cancer Center, 1007, Shizuoka, Japan
| | - Takeshi Kawakami
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007, Shizuoka, Japan
| | - Hirofumi Ogawa
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007, Shizuoka, Japan
| | - Tsuyoshi Onoe
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007, Shizuoka, Japan
| | - Takashi Mukaigawa
- Division of Head and Neck Surgery, Shizuoka Cancer Center, 1007, Shizuoka, Japan
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Zhang D, Li L, Wen T, Wu Y, Ma F. Prognostic Nomogram for Postoperative Hypopharyngeal Squamous Cell Carcinoma to Assist Decision Making for Adjuvant Chemotherapy. J Clin Med 2022; 11:jcm11195801. [PMID: 36233674 PMCID: PMC9573651 DOI: 10.3390/jcm11195801] [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: 08/22/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022] Open
Abstract
We aimed to investigate the effect of lymph node parameters on postoperative hypopharyngeal squamous cell carcinoma (HSCC) and to establish a nomogram to predict its prognosis and assist in adjuvant chemotherapy decisions. A retrospective analysis of postoperative HSCC in the Surveillance, Epidemiology, and End Results database (2004-2019) was performed. Cutoff points for continuous variables were determined by X-tile software. Univariate and multivariate analyses were performed to identify prognostic factors on overall survival (OS), and these variables were used to construct a nomogram. The nomogram's accuracy was internally validated using concordance index, area under the curve, calibration plot, and decision curve analyses. Furthermore, the value of chemotherapy in each risk subgroup was assessed separately based on individualized scores from the nomogram. In total, 404 patients were eligible for analysis, and the median OS was 39 months. Age, origin, primary site, T stage, number of lymph nodes examined, lymph node ratio, and radiotherapy were identified as prognostic factors for OS and incorporated into the nomogram. In both the training and validation cohorts, favorable performance was exhibited compared with the other stage systems, and patients could be classified into low-, intermediate-, and high-risk subgroups. Chemotherapy significantly improved the OS in the high-risk subgroup, whereas chemotherapy did not confer a survival benefit in the low- or intermediate-risk groups. The lymph node parameter-based nomogram model can better stratify the prognosis of HSCC patients and screen out patients who would benefit from chemotherapy, suggesting that the model could be used as a reference for clinical decision making and to avoid overtreatment.
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Affiliation(s)
| | | | | | | | - Fei Ma
- Correspondence: ; Tel.: +86-010-87788060; Fax: +86-010-87715711
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Pang W, Luo Y, Li J, Cheng D, Rao Y, Mao M, Qiu K, Dong Y, Liu J, Zou J, Wang H, Chen F. The Prognostic Prediction Value of Positive Lymph Nodes Numbers for the Hypopharyngeal Squamous Cell Carcinoma. Front Med (Lausanne) 2022; 9:898483. [PMID: 35860727 PMCID: PMC9291443 DOI: 10.3389/fmed.2022.898483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe current American Joint Committee on Cancer (AJCC) system only considered the importance of the size and laterality of lymph nodes while not the positive lymph node number (PLNN) for hypopharyngeal squamous cell carcinoma (HPSCC).MethodsA total of 973 patients with HPSCC from the Surveillance, Epidemiology, and End Results database (2004–2015) were identified. Univariate and multivariate Cox regression analyses were used to evaluate the prognostic effects. We applied six Cox regression models to compare the survival prognostic values of PLNN and AJCC systems.ResultsPositive lymph node number showed a significant association with overall survival (OS) and cancer-specific survival (CSS) (P < 0.001) in univariate and multivariable analyses. The increased PLNN of HPSCC gave rise to poor OS and CSS. The survival model incorporating a composite of PLNN and TNM classification (C-index for OS:0.682, C-index for CSS:0.702) performed better than other models.ConclusionsA positive lymph node number could serve as a survival predictor for patients with HPSCC and a complement to enhance the prognostic assessment effects of TNM cancer staging systems.
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Affiliation(s)
- Wendu Pang
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yaxin Luo
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Junhong Li
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Danni Cheng
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yufang Rao
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Minzi Mao
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Qiu
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yijun Dong
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Liu
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Zou
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Haiyang Wang
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
- Haiyang Wang
| | - Fei Chen
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Fei Chen
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Yang X, Liu J. Targeting PD-L1 (Programmed death-ligand 1) and inhibiting the expression of IGF2BP2 (Insulin-like growth factor 2 mRNA-binding protein 2) affect the proliferation and apoptosis of hypopharyngeal carcinoma cells. Bioengineered 2021; 12:7755-7764. [PMID: 34608837 PMCID: PMC8806995 DOI: 10.1080/21655979.2021.1983278] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Programmed cell death-ligand 1 (PD-L1) have been attracting increasing attention in cancer diagnosis and treatment. The insulin-like growth factor 2 mRNA-binding protein 2 (IGF2BP2) is involved in the progression of multiple types of cancer. So, the role of IGF2BP2 and PD-L1 in hypopharyngeal carcinoma was assessed. Western blotting and immunochemistry were used to evaluate the expression of IGF2BP2 and PD-1/PD-L1. IGF2BP2 expression was knocked down in FaDu cells, and the effects on cell viability, apoptosis and proliferation were measured. A tumor-bearing nude model of hypopharyngeal carcinoma was constructed to evaluate the effect of a PD-L1 inhibitor and IGF2BP2 knockdown on hypopharyngeal carcinoma in vivo. RNA pull-down assays were used to assess the interaction between IGF2BP2 and PD-L1. The results showed that knockdown of IGF2BP2 inhibited FaDu cell proliferation and promoted apoptosis, as evidenced by the lower cell viability, a higher ratio of TUNEL-positive cells, decreased expression of Bcl-2 and cyclins, and increased expression of cleaved-caspase 3. In vivo, the tumor volume and weight were reduced by both the PD-L1 inhibitor and IGF2BP2 knockdown. Additionally, the interaction between PD-L1 and IGF2BP2 was confirmed. In conclusion, the results in the present study revealed that inhibition of IGF2BP2 might be a potentially relevant method for treating hypopharyngeal carcinoma, and the effects might be mediated via inhibition of the PD-1/PD-L1 axis.
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Affiliation(s)
- Xudong Yang
- Department of Otolaryngology, First Affiliated Hospital of Soochow University, Soochow, Jiangsu, P.R. China.,Department of Otolaryngology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China
| | - Jisheng Liu
- Department of Otolaryngology, First Affiliated Hospital of Soochow University, Soochow, Jiangsu, P.R. China
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Nocon CC, Kuchta K, Bhayani MK. Prognostic value of lymph node ratio versus American Joint Committee on Cancer N classification for surgically resected human papillomavirus-associated oropharyngeal squamous cell carcinoma. Head Neck 2021; 43:1476-1486. [PMID: 33415799 DOI: 10.1002/hed.26605] [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: 05/30/2020] [Revised: 11/15/2020] [Accepted: 12/30/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We compared prognostic values of lymph node ratio (LNR) and AJCC 8 N classification in surgically resected human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). METHODS Using the National Cancer Database, we identified patients with HPV-associated OPSCC from 2010 to 2016 who underwent definitive surgical resection. Patients were analyzed by nodal grouping (LNR, N stage) and adjuvant radiation therapy(RT). Primary endpoint was overall survival. RESULTS We identified 4166 patients. Survival analysis showed significant improvement for LNR≤6% versus >6% (5 year OS% 92.7% vs. 83.7%, p < 0.001). N classification demonstrated good prognostic ability (5 year OS% for pN0, pN1, pN2 were 91.3%, 90.1%, 78.8%, p < 0.001), but poor separation among stages (compared to pN0: pN1 HR 1.40 [95% CI 0.63, 3.09], p = 0.41; pN2 HR 2.50 [95% CI 1.08, 5.81], p = 0.033). RT improved survival in the LNR > 6% group (5 year OS% 85.4% vs. 74.9%, p < 0.001; HR 0.41 [95% CI 0.28, 0.58], p < 0.001). CONCLUSIONS LNR should be considered an adjunct category in future staging systems for HPV-associated OPSCC.
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Affiliation(s)
- Cheryl C Nocon
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA.,Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Kristine Kuchta
- Research Institute, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Mihir K Bhayani
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA.,Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
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Faisal M, Dhanani R, Ullah S, Bakar MA, Irfan N, Malik KI, Loya A, Boban EM, Hussain R, Jamshed A. Prognostic outcomes of treatment naïve oral tongue squamous cell carcinoma (OTSCC): a comprehensive analysis of 14 years. Eur Arch Otorhinolaryngol 2020; 278:3045-3053. [PMID: 33236214 DOI: 10.1007/s00405-020-06482-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/07/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To analyze the factors predicting survival outcomes in treatment naïve oral tongue squamous cell carcinoma (OTSCC). MATERIALS AND METHODS A comprehensive review of 531 oral tongue carcinoma patients treated with upfront surgery followed by adjuvant radiotherapy or chemoradiotherapy was conducted from 2004-2018. RESULTS The mean age of presentation was 53 years (11-86) with a male to female ratio of 1.3:1. The associated risk factors were smoking (21%), betel nut (16%), naswar (9%) and alcohol (1%). Most of the cases were either well (45.1%) or moderately (46.2%) differentiated. Surgery was performed in 164 patients alone while 368 were treated with surgery in combination with adjuvant modalities. Overall (OS) and disease free survival (DFS) were 66 and 71%, respectively, with a median follow up of 2.5 years. Cox regression analysis showed nodal positivity, increased depth of invasion (DOI) and higher lymph node ratio (LNR) as significant prognosticators impacting OS and DSS. CONCLUSION Nodal volume, DOI and LNR are the most consistent predictors of poor outcome in OTSCC. Nodal positivity, depth of invasion > 5 mm and lymph node ratio > 0.04 adversely affect OS and DSS.
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Affiliation(s)
- Muhammad Faisal
- Department of Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.
| | - Rahim Dhanani
- Department of Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Sami Ullah
- Department of Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Muhammad Abu Bakar
- Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Nabia Irfan
- Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Kashif Iqbal Malik
- Department of Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Asif Loya
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Erovic M Boban
- Department of Head and Neck Surgery, Evangelisches Krankenhaus, Vienna, Austria
| | - Raza Hussain
- Department of Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Arif Jamshed
- Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
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León X, Neumann E, Gutierrez A, García J, Quer M, López M. Prognostic capacity of the lymph node ratio in squamous cell carcinomas of the head and neck. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71:265-274. [PMID: 32473713 DOI: 10.1016/j.otorri.2020.04.001] [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: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Lymph node density or lymph node ratio (LNR), defined as the quotient between the total number of positive lymph nodes and the total number of dissected lymph nodes, has demonstrated a prognostic capacity in several tumour models, including patients with head and neck squamous cell carcinomas (HNSCC). The aim of the present study is to analyse the prognostic value of LNR in a wide cohort of patients with HNSCC. METHODS We carried out a retrospective study of a cohort of 1,311 patients with HNSCC treated with unilateral or bilateral neck dissections. Of the patients included in the study, 55.0% had lymph node metastases (pN+). We proceeded to calculate the value of the LNR, and its categorization through a recursive partition analysis considering specific survival as the dependent variable. RESULTS Three categories were defined according to the value of the LNR with a cut-off point at the values < of .025 and .118. The 5-year specific survival for patients with an LNR less than .025 (n=654, 49.8%) was 87.2%, for patients with a LNR .025-.118 (n=394, 30.1%) it was 51.6%, and for patients with a LNR greater than .188 (n=263, 20.1%) it was 27.3% (P=.0001). According to the results of a multivariate analysis, the LNR significantly related to specific survival. CONCLUSION The LNR can be a prognostic variable to be considered in the pathological staging of the lymph nodes.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España.
| | - Eduard Neumann
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Alfons Gutierrez
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
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Abdeyrim A, He S, Zhang Y, Mamtali G, Asla A, Yusup M, Liu J. Prognostic value of lymph node ratio in laryngeal and hypopharyngeal squamous cell carcinoma: a systematic review and meta-analysis. J Otolaryngol Head Neck Surg 2020; 49:31. [PMID: 32471483 PMCID: PMC7257235 DOI: 10.1186/s40463-020-00421-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/22/2020] [Indexed: 12/21/2022] Open
Abstract
Background Several recent studies have indicated that the lymph node ratio (LNR) is an independent prognostic factor for laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC). The purpose of this paper is to assess the prognostic value of LNR and explore appropriate cutoff values by conducting a systematic review and meta-analysis. Methods Pubmed, Embase (via Ovid), and Cochrane library were systematically searched for studies on the prognostic value of LNR in LHSCC up to October 31, 2019. Then, Literature review, data extraction, and quality assessment of eligible studies were performed by two independent reviewers back-to-back. Lastly, Stata 14.0 software was hired to conduct a meta-analysis. Results A total of 445 articles were retrieved, and 13 studies published in English between 2013 and 2019 were included after the title/abstract and full-text screening. Among the 13 studies contributed to 4197 patients, seven studies were about hypopharyngeal squamous cell carcinoma (HPSCC), four studies about laryngeal squamous cell carcinoma (LSCC), and the remaining two studies about LHSCC. The meta-analysis results showed that shorter overall survival (OS) (HR 1.49; 95%CI: 1.18 to 1.88), disease-specific survival (DSS) (HR 1.66; 95%CI: 1.32 to 2.07) and disease-free survival (DFS) (HR 2.04; 95%CI: 1.54 to 2.71) were significantly correlated with a higher LNR in a random-effect model. The cutoff values of eligible studies were varied from 0.03 to 0.14, and the lowest significant LNR was 0.044. Conclusion LNR is a valuable prognostic factor in the survival of LHSCC and may be used to improve the tumor staging systems, which, however, requires the solid support of more high-quality studies.
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Affiliation(s)
- Arikin Abdeyrim
- Department of Otorhinolaryngology Head and Neck Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Tianshan, Ürümqi, Xinjiang, 830001, China.
| | - Shizhi He
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Department of Otorhinolaryngology, China-Japan Friendship Hospital, Beijing, China
| | - Gulbostan Mamtali
- Department of Otorhinolaryngology Head and Neck Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Tianshan, Ürümqi, Xinjiang, 830001, China
| | - Aibadla Asla
- Department of Otorhinolaryngology Head and Neck Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Tianshan, Ürümqi, Xinjiang, 830001, China
| | - Mirkamil Yusup
- Department of Otorhinolaryngology Head and Neck Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Tianshan, Ürümqi, Xinjiang, 830001, China
| | - Jiang Liu
- Department of Neurosurgery, China-Japan Friendship Hospital, No. 2, Yinghua East Street, Chaoyang District, Beijing, 100029, China.
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12
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Lin P, Tian P, Pang J, Lai L, He G, Song Y, Zheng Y. Clinical significance of COL1A1 and COL1A2 expression levels in hypopharyngeal squamous cell carcinoma. Oncol Lett 2020; 20:803-809. [PMID: 32566007 PMCID: PMC7285875 DOI: 10.3892/ol.2020.11594] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 04/03/2020] [Indexed: 12/28/2022] Open
Abstract
Alterations in collagen type I α1 (COL1A1) and collagen type I α 2 (COL1A2) expression levels have been reported to predict prognosis in various types of cancer. However, the effect of these biomarkers on hypopharyngeal squamous cell carcinoma (HPSCC) is yet to be fully elucidated. The present study aimed to explore the prognostic significance of COL1A1 and COL1A2 expression levels in HPSCC. The expression levels of COL1A1 and COL1A2 in 67 patients with HPSCC were examined using an immunohistochemical assay in a tissue microarray. The associations between COL1A1/COL1A2 expression levels and patient clinicopathological features were analyzed using ANOVA, Pearson's χ2 or Fisher's exact test. The Cox proportional hazard models and Kaplan-Meier survival analysis with log-rank tests were used to analyze the significance of COL1A1/COL1A2 as prognostic markers for patients with HPSCC. As a result, immunohistochemical staining revealed that COL1A1 was positively expressed in all cases, among which 40.3% were strong positive, while COL1A2 was positively expressed in 76.1% of the HPSCC cases with 6.0% of the samples exhibiting strong staining. Further analysis revealed no significant association between the expression levels of COL1A1/COL1A2 and other clinicopathological features. Cox regression analysis revealed that a high COL1A2 expression level predicted a high locoregional recurrence and a less favorable disease-free survival rate (P=0.042 and 0.020, respectively). Overall, the present study indicated that COL1A2 expression levels may have value as a prognostic indicator in HPSCC.
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Affiliation(s)
- Peiliang Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Peng Tian
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Jiaqi Pang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Lan Lai
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Gui He
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Yang Song
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Yiqing Zheng
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
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13
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Yeung DCM, Yeung Z, Wong EWY, Vlantis AC, Chan JYK. Neck lymph node status on survival of regionally recurrent or persistent nasopharyngeal carcinoma. Sci Rep 2020; 10:5622. [PMID: 32221400 PMCID: PMC7101328 DOI: 10.1038/s41598-020-62625-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/17/2020] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to evaluate the impact of lymph node status from neck dissection pathological specimens on the survival for isolated regional nodal recurrence or persistence after primary treatment of nasopharyngeal carcinoma. Through a retrospective cohort study performed in an academic tertiary referral hospital in Hong Kong. Forty-six patients who underwent a salvage neck dissection between June 2001 and January 2013 for isolated regionally recurrent or persistent nasopharyngeal carcinoma was performed. Informed consent was waived for this retrospective study by The Joint CUHK-NTEC CREC. In the study forty-six patients had a salvage neck dissection for nodal failure with a mean age of 53 and 74% (34) were male. With a mean follow-up of 45.3 months, Overall survival, disease specific survival, loco-regional recurrence free survival, and regional recurrence free survival were 56.5%, 73.9%, 87.0%, and 91.3% respectively. For both univariate and multivariate analysis, patients with a number of positive lymph nodes more than 5 and a lymph node density more than 20% were significantly associated with poorer overall survival. Extracapsular spread and pathological cervical lymph node staging did not have an association with poorer survival. In conclusion, an absolute number of positive lymph nodes more than five and a lymph node density more than 20% were potentially useful prognostic factors affecting survival following a neck dissection for regional residual or recurrent nasopharyngeal carcinoma.
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Affiliation(s)
- David C M Yeung
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong, Kong SAR, China
| | - Zenon Yeung
- Department of Ear Nose & Throat, United Christian Hospital, Affiliated Teaching Unit of the Chinese University of Hong Kong, Kwun Tong, Hong Kong SAR, China
| | - Eddy W Y Wong
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong, Kong SAR, China
| | - Alexander C Vlantis
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong, Kong SAR, China
| | - Jason Y K Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong, Kong SAR, China.
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14
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Zhang X, Yu F, Zhao Z, Mai J, Zhou Y, Tan G, Liu X. The Prognostic Significance of Lymph Node Ratio and Log Odds Ratio in Laryngeal Squamous Cell Carcinoma. OTO Open 2018; 2:2473974X18792008. [PMID: 31535064 PMCID: PMC6737873 DOI: 10.1177/2473974x18792008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/03/2018] [Accepted: 07/11/2018] [Indexed: 11/21/2022] Open
Abstract
Objective To investigate whether lymph node ratio (LNR) and log odds ratio (LODDS) have prognostic significance for overall survival (OS) and disease-free survival (DFS) in patients with laryngeal squamous cell cancer (LSCC) treated with curative intent. Study Design Case-control study. Setting University hospital. Subjects and Methods Records of 229 patients with LSCC who underwent surgery with a curative intent with or without adjuvant treatment from 2000 to 2014 were reviewed. The clinicopathological parameters LNR and LODDS were analyzed; univariate and multivariate analysis was performed to evaluate the prognosis of each for OS and DFS. Results The 5-year OS was 81.7% for LNR ≤0.233 and 47.1% for LNR >0.233, and the 5-year OS was 79.6% for LODDS ≤–0.1 and 51.8% for LODDS >–0.1, respectively. In the univariate analysis, the independent variables were subsites, pT stage (pT1 and pT2 vs pT3 and pT4), pN, pTNM, alcohol consumption, and LNR and LODDS (P < .05). By multivariate analysis, we determined that subsites, pT stage, alcohol consumption, LNR, and LODDS were independent prognostic predictors of survival (P < .05). Univariate and multivariate models identified that both LNR and LODDS were significant prognostic factors for survival. However, the hazard ratio (HR) for LNR >0.233 vs ≤0.233 was 8.95 (95% confidence interval [CI], 3.18-25.16; P < .001) in OS, and the HR was 11.37 (95% CI, 4.02-32.15; P < .001) in DFS. The risk of LNR was noticeably greater than other factors. Conclusions LNR and LODDS were both prognostic factors for OS and DFS. However, LNR was confirmed as a more reliable indicator for evaluating the prognosis, and it can be used to increase the prognostic value of the traditional TNM classification of LSCC.
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Affiliation(s)
- Xinrui Zhang
- Department of Otorhinolaryngology, Guangzhou Otolaryngology-Head and Neck Surgery Hospital, Guangzhou, Guangdong, P.R. China.,Institute of Otolaryngology-Head and Neck Surgery, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Feng Yu
- Department of Otorhinolaryngology, Guangzhou Otolaryngology-Head and Neck Surgery Hospital, Guangzhou, Guangdong, P.R. China.,Institute of Otolaryngology-Head and Neck Surgery, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Zheng Zhao
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, Guangdong, P.R. China.,Department of Head and Neck Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Junhao Mai
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, Guangdong, P.R. China.,Department of Head and Neck Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Yibo Zhou
- Department of Otorhinolaryngology, Guangzhou Otolaryngology-Head and Neck Surgery Hospital, Guangzhou, Guangdong, P.R. China.,Institute of Otolaryngology-Head and Neck Surgery, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Guojie Tan
- Department of Otorhinolaryngology, Guangzhou Otolaryngology-Head and Neck Surgery Hospital, Guangzhou, Guangdong, P.R. China.,Institute of Otolaryngology-Head and Neck Surgery, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Xuekui Liu
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, Guangdong, P.R. China.,Department of Head and Neck Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
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15
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Sano D, Yabuki K, Takahashi H, Arai Y, Chiba Y, Tanabe T, Nishimura G, Oridate N. Lymph node ratio as a prognostic factor for survival in patients with head and neck squamous cell carcinoma. Auris Nasus Larynx 2018; 45:846-853. [DOI: 10.1016/j.anl.2017.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/10/2017] [Accepted: 11/21/2017] [Indexed: 12/19/2022]
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16
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Eshraghi Samani R, Shirkhoda M, Hadji M, Beheshtifard F, Hamedani SMMG, Momen A, Mollashahi M, Zendehdel K. The prognostic value of lymph node ratio in survival of head-and-neck squamous cell carcinoma. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2018; 23:35. [PMID: 29887903 PMCID: PMC5961280 DOI: 10.4103/jrms.jrms_948_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/14/2017] [Accepted: 01/31/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Head-and-neck squamous cell carcinoma (HNSCC) is the sixth most prevalent type of cancers in the world. Due to its relatively high rate of recurrence, the prognosis of patients is poor and the survival rate is low; therefore, identifying the prognostic factors is considered necessary for better treatment. MATERIALS AND METHODS This historical cohort study was conducted on 201 patients diagnosed with aerodigestive SCC who underwent surgery and lymph node dissection. We determined the prognostic value of lymph node ratio (LNR) on overall survival (OS), disease-free survival (DFS), and locoregional failure-free survival (LFFS). We noticed an association between LNR and survival by Kaplan-Meier analysis. Hazard ratio (HR) of LNR was determined by Cox's regression model. RESULTS Two hundred and one patients entered this study after their medical histories were evaluated. The mean of lymph node count and LNR was 14.30 (±9.50) and 0.12 (±0.23), respectively. Eighty patients (39.80%) experienced recurrence of SCC. Five-year OS, DFS, and LFFS were 32%, 21%, and 64%, respectively. The median of OS was 40.70 months and 30.11 months in patients with LNR of ≤0.06 and >0.06, respectively (P < 0.01). The LNR >0.06 was found to be a significant prognostic factor for lower OS of patients with HNSCC (HR = 2.11 [1.10, 4.40]; P = 0.04). DFS was not significantly different among patients with LNR ≤0.06 and patients with LNR >0.06 (P = 0.9). However, LFFS was slightly different among two groups (HR = 2.04 [0.90-4.80]; P < 0.1). CONCLUSION We recommend more intensive adjuvant therapies such as chemotherapy with radiotherapy and short interval follow-up for patients with LNR >0.06. Further investigations with larger sample sizes are recommended.
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Affiliation(s)
- Reza Eshraghi Samani
- Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
- Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Mohammad Shirkhoda
- Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Maryam Hadji
- Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Faramarz Beheshtifard
- Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Seyed Mohammad Mehdi Ghaffari Hamedani
- Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran, Iran
- Department of Surgery, Mazandaran University of Medical Sciences, Mazandaran, Iran
| | - Ali Momen
- Resident of General Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahtab Mollashahi
- Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran, Iran
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17
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Talmi YP, Takes RP, Alon EE, Nixon IJ, López F, de Bree R, Rodrigo JP, Shaha AR, Halmos GB, Rinaldo A, Ferlito A. Prognostic value of lymph node ratio in head and neck squamous cell carcinoma. Head Neck 2018; 40:1082-1090. [PMID: 29394461 DOI: 10.1002/hed.25080] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 07/10/2017] [Accepted: 12/06/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Lymph node ratio (LNR) is increasingly reported as a potential prognostic tool. The purpose of this review was to analyze the available literature on the prognostic significance of LNR in head and neck squamous cell carcinoma (HNSCC). METHODS A PubMed internet search was performed and articles meeting selection criteria were reviewed. RESULTS Twenty-eight studies were identified in the literature dealing with the prognostic value of LNR. The published results are variable with a range of cutoff values of LNR associated with prognosis (overall survival [OS] and/or disease-specific survival [DSS]) between 0.02 and 0.20, with an average of 0.09. CONCLUSION The LNR is reported to be of value in assessing prognosis in the patients with HNSCC. Although it is easy to calculate and could be considered in the staging of these patients, the currently available evidence in the literature does not yet provide a solid base for implementation.
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Affiliation(s)
- Yoav P Talmi
- Department of Otolaryngology - Head and Neck Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel and the Sackler School of Medicine, Tel Aviv University, Israel
| | - Robert P Takes
- Department of Otolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eran E Alon
- Department of Otolaryngology - Head and Neck Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel and the Sackler School of Medicine, Tel Aviv University, Israel
| | - Iain J Nixon
- Ear, Nose, and Throat Department, NHS Lothian, Lauriston Building, Lauriston Place, Edinburgh, UK
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, and Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain.,Head and Neck Oncology Unit, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, and Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain.,Head and Neck Oncology Unit, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Groningen University Medical Center Groningen, Groningen, The Netherlands
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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18
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Jacobi C, Rauch J, Hagemann J, Lautz T, Reiter M, Baumeister P. Prognostic value of the lymph node ratio in oropharyngeal carcinoma stratified for HPV-status. Eur Arch Otorhinolaryngol 2017; 275:515-524. [PMID: 29204919 DOI: 10.1007/s00405-017-4833-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 11/29/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Lymph node ratio (LNR) was shown to be a prognostic factor in laryngeal and oral cavity primaries. The purpose of this study was to investigate the impact of the lymph node ratio in oropharyngeal squamous cell carcinoma (OPSCC) with a high incidence of HPV-related disease. Therefore, the role of LNR was evaluated as an additional predictive parameter to the 8th edition of AJCC TNM staging system. METHODS From December 2009 to August 2015, patients diagnosed with primary oropharyngeal squamous cell carcinoma were prospectively enrolled. After tumor resection with uni- or bilateral neck dissection, patients with ≥ 1 nodal metastasis (pN+) were eligible for a retrospective LNR analysis. RESULTS 137 patients underwent tumor resection with uni- or bilateral neck dissection. The proportion of HPV-associated disease was 42%. Most patients (n = 96; 70%) presented with involved neck nodes. In p16-positive OPSCC, the rate of pN + cases was significantly increased compared to p16-negative OPSCC (86% vs. 58%, p = 0.007). Patients with LNR ≤ 10% had a significant better overall survival (OS) and disease-specific survival (DSS). However, when stratified for p16-status, LNR ≤ 10% had a significant impact on OS only for HPV-associated tumors (p = 0.027), whereas LNR of ≤ 10% was not a significant predictor for better OS in p16-negative OPSCC (p = 0.143). CONCLUSION The LNR with a cut-off value of 10% serves as an additional prognostic parameter in HPV-related OPSCC and may help to improve risk stratification in combination with the revised AJCC 8th edition TNM classification.
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Affiliation(s)
- Christian Jacobi
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany.
| | - Josepha Rauch
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Jan Hagemann
- Department of Otorhinolaryngology, Head and Neck Surgery, Johannes-Gutenberg-University Medical Center, Langenbeckstraße 1, Mainz, 55131, Germany
| | - Thomas Lautz
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximilian Reiter
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Philipp Baumeister
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany.,Clinical Cooperation Group Personalized Radiotherapy in Head and Neck Cancer, Helmholtz Center, Munich, Germany
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19
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de Ridder M., Marres C, Smeele L, van den Brekel M, Hauptmann M, Balm A, van Velthuysen M. A critical evaluation of lymph node ratio in head and neck cancer. Virchows Arch 2016; 469:635-641. [DOI: 10.1007/s00428-016-2015-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/13/2016] [Accepted: 08/30/2016] [Indexed: 10/21/2022]
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20
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Adel M, Tsao CK, Wei FC, Chien HT, Lai CH, Liao CT, Wang HM, Fan KH, Kang CJ, Chang JTC, Huang SF. Preoperative SCC Antigen, CRP Serum Levels, and Lymph Node Density in Oral Squamous Cell Carcinoma. Medicine (Baltimore) 2016; 95:e3149. [PMID: 27057838 PMCID: PMC4998754 DOI: 10.1097/md.0000000000003149] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/24/2016] [Accepted: 02/24/2016] [Indexed: 01/29/2023] Open
Abstract
The prognostic significance of squamous cell carcinoma antigen (SCC-Ag) and C-reactive protein (CRP) levels and lymph node density (LND) has been individually recognized in oral squamous cell carcinoma (OSCC). We investigated the relationship between preoperative serum markers (SCC-Ag and CRP) and postoperative prognostic marker (LND) in this study. We retrospectively analyzed 277 OSCC patients who underwent primary curative resection and neck dissection with/or without adjuvant therapy between March 2008 and November 2013. Serum SCC-Ag and CRP levels were measured preoperatively. Distant metastasis, overall survival (OS), and disease-free survival (DFS) were used to evaluate the prognostic significance of preoperative SCC-Ag and CRP levels in relation to LND. LND (cutoff point ≥0.06) correlated with the pathologic tumor status, pathologic nodal metastasis, degree of differentiation, tumor stage, tumor depth (≥10 mm vs <10 mm), and perineural invasion (all P values were <0.001). LND was significantly associated with development of distant metastasis, DFS, and OS (all P values were <0.001). Preoperative elevated CRP and SCC-Ag levels were significantly associated with LND (P = 0.006), DFS (P < 0.001), and OS (P < 0.001). LND patients were further stratified into prognostic groups according to their SCC-Ag and CRP levels (DFS: P = 0.010; OS: P = 0.003). LND correlated with the incidence of DM, DFS, and OS in patients with OSCC. Concurrent elevated preoperative SCC-Ag and CRP levels are predictors for LND. In addition, SCC-Ag and CRP are markers for classifying high-risk LND patients with OSCC into subgroups.
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Affiliation(s)
- Mohamad Adel
- From the Department of Surgery (MA), Division of Surgical Oncology, Al-Azhar University Hospitals, Al-Azhar Faculty of Medicine, Cairo, Egypt, Department of Otolaryngology (MA, CTL, CJK, SFH), Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University (CKT, FCW), Department of Epidemiology (HTC, CHL), Department of Medical Oncology (HMW), and Department of Radiation Oncology (KHF, JTC), Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, China
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Hong HR, Roh JL, Cho KJ, Choi SH, Nam SY, Kim SY. Prognostic value of lymph node density in high-grade salivary gland cancers. J Surg Oncol 2015; 111:784-9. [DOI: 10.1002/jso.23874] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 11/26/2014] [Indexed: 02/01/2023]
Affiliation(s)
- Hye Ran Hong
- Departments of Otolaryngology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - Jong-Lyel Roh
- Departments of Otolaryngology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - Kyung-Ja Cho
- Departments of Pathology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - Seung-Ho Choi
- Departments of Otolaryngology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - Soon Yuhl Nam
- Departments of Otolaryngology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - Sang Yoon Kim
- Departments of Otolaryngology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
- Departments of Biomedical Research Institute; Korea Institute of Science and Technology; Seoul Republic of Korea
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Srivastava VK, Gara RK, Rastogi N, Mishra DP, Ahmed MK, Gupta S, Goel MM, Bhatt MLB. Serum vascular endothelial growth factor-A (VEGF-A) as a biomarker in squamous cell carcinoma of head and neck patients undergoing chemoradiotherapy. Asian Pac J Cancer Prev 2015; 15:3261-5. [PMID: 24815480 DOI: 10.7314/apjcp.2014.15.7.3261] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate serum VEGF-A levels in squamous cell carcinoma of head and neck (SCCHN) patients and relationships with response to therapy. MATERIALS AND METHODS Serum VEGF-A levels in patients (n=72) treated with radiotherapy (RT) or radio-chemotherapy (RCT) and controls (n=40) were measured by ELISA. RESULTS Serum VEGF-A levels of the SCCHN cases were significantly higher (p=0.001) than in healthy controls, and in patients with positive as compared to negative lymph node status (p=0.004). Similarly, patients with advanced stage (Stage III-IV) disease had more greatly elevated levels of serum VEGF-A level than their early stage (Stage I-II) counterparts (p=0.001). In contrast, there was no significant difference (p=0.57) in serum level of VEGF-A in patients with advanced T-stage (T3-4) as compared to early stage (T1-2). Similarly, patients with distant metastasis had no significant (p=0.067) elevation in serum VEGF-A level as compared to non-metastatic disease. However, the non-responder patients had significantly higher serum VEGF-A level as compared to responders (p=0.001). CONCLUSIONS Our results suggest that the serum VEGF-A level may be a useful biomarker for the prediction of response to therapy in SCCHN.
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Affiliation(s)
- Vikas Kumar Srivastava
- Department of Radiotherapy, King George's Medical University, Uttar Pradesh, India E-mail :
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23
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Kuo P, Chen MM, Decker RH, Yarbrough WG, Judson BL. Hypopharyngeal cancer incidence, treatment, and survival: temporal trends in the United States. Laryngoscope 2014; 124:2064-9. [PMID: 25295351 DOI: 10.1002/lary.24651] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective was to characterize incidence, treatment, and survival for hypopharyngeal cancer in the United States between 1988 and 2010, and to analyze associations between changes in treatment modality and survival. STUDY DESIGN Retrospective cohort study. METHODS A total of 3,958 adult patients with hypopharyngeal cancer were identified in the Surveillance, Epidemiology, and End Results database. Incidence, treatment, and survival, controlling for patient demographics and disease severity, were analyzed using two-tailed t tests, Kaplan-Meier analysis, and univariate and multivariate Cox regression. RESULTS The incidence of hypopharyngeal cancer decreased from 1973 to 2010 with an average annual percent change (APC) of -2.0% every year (P < .05). Treatment with laryngopharyngectomy decreased (-2.5% APC, P < .001), treatment with radiotherapy without surgery increased (+2.0% APC, P < .001), and treatment with neither surgery nor radiotherapy increased (+0.5% APC, P < .001) between 1988 and 2010. There was a significant increase in the 5-year overall survival between 1988 and 1990 and between 1991 and 1995 (P = .024) with no other significant temporal trends in survival. Multivariate analysis revealed that age (65-74, 75-84, or 85+ relative to 18-54 years old), race (white relative to non-African races), T stage (T2, T3, or T4 relative to T1), N stage (N2 or N3 relative to N0), and treatment modality (-surgery/-radiation, -surgery/+radiation, and +surgery/-radiation relative to +surgery/+radiation) were all significantly associated with worse survival. CONCLUSIONS Hypopharyngeal cancer has had a decreasing incidence with little change in patient or tumor characteristics. Treatment has increasingly involved radiation without laryngopharyngectomy. This has not been associated with a decrease in survival. Controlling for patient demographics and disease severity, radiation with laryngopharyngectomy is associated with improved survival.
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24
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Qian W, Zhu G, Wang Y, Wang X, Ji Q, Wang Y, Dou S. Multi-modality management for loco-regionally advanced laryngeal and hypopharyngeal cancer: balancing the benefit of efficacy and functional preservation. Med Oncol 2014; 31:178. [DOI: 10.1007/s12032-014-0178-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 08/09/2014] [Indexed: 12/20/2022]
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25
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Ryu IS, Roh JL, Cho KJ, Choi SH, Nam SY, Kim SY. Lymph node density as an independent predictor of cancer-specific mortality in patients with lymph node-positive laryngeal squamous cell carcinoma after laryngectomy. Head Neck 2014; 37:1319-25. [PMID: 24828891 DOI: 10.1002/hed.23750] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 02/04/2014] [Accepted: 05/07/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We examined the prognostic value of lymph node density in predicting cancer-specific mortality (CSM) for patients with lymph nodes positive (pN+) laryngeal squamous cell carcinoma (SCC) after laryngectomy. METHODS The records of 156 patients with laryngeal SCC who initially underwent curative resection of the primary tumor combined with neck dissection were reviewed. RESULTS The 5-year cumulative incidence of CSM was 20.4%. N classification and extralaryngeal spread (ELS) were independent variables for CSM in all patients. Univariate analyses in 71 pN+ patients showed that ELS, number of positive lymph nodes >4, and lymph node density >0.044 were significantly associated with increased CSM, whereas pN classification was not (p = .218). On multivariate analysis, lymph node density ≥0.044 remained an independent predictor of CSM (p = .001). CONCLUSION Among the pN+ patients with laryngeal SCC, no pN classification but lymph node density was noted to have an independent impact on CSM.
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Affiliation(s)
- In Sun Ryu
- Department of Otolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung-Ja Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, Republic of Korea
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26
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Künzel J, Mantsopoulos K, Psychogios G, Grundtner P, Koch M, Iro H. Lymph node ratio as a valuable additional predictor of outcome in selected patients with oral cavity cancer. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:677-84. [DOI: 10.1016/j.oooo.2014.02.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 02/22/2014] [Accepted: 02/28/2014] [Indexed: 11/27/2022]
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27
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Prabhu RS, Hanasoge S, Magliocca KR, Hall WA, Chen SA, Higgins KA, Saba NF, El-Deiry M, Grist W, Wadsworth JT, Chen AY, Beitler JJ. Lymph node ratio influence on risk of head and neck cancer locoregional recurrence after initial surgical resection: implications for adjuvant therapy. Head Neck 2014; 37:777-82. [PMID: 24596123 DOI: 10.1002/hed.23662] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/14/2013] [Accepted: 03/02/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine if lymph node ratio is associated with locoregional recurrence for patients with oral cavity or laryngeal cancer treated with initial surgical management. METHODS The study included 350 patients with oral cavity (73%) or laryngeal cancer (27%) who underwent initial surgery. All analyses were multivariable, adjusting for primary site, pathologic prognostic factors, and adjuvant therapy. RESULTS Lymph node ratio was significantly associated with locoregional recurrence, in which each 1% increase in lymph node ratio had an adjusted hazard ratio (HR) for locoregional recurrence of 1.02 (95% confidence interval [CI], 1.002-1.042; p = .05). Lymph node ratio was also associated with OS, in which each 1% increase in lymph node ratio had an adjusted HR for death of 1.028 (95% CI, 1.012-1.045; p = .001). CONCLUSION Adjusting for pathologic factors and adjuvant therapy, lymph node ratio was found to be an independent prognostic factor for locoregional recurrence and overall survival (OS). Patients with lymph node ratio ≥20% are at high risk of locoregional recurrence and death, and may be considered for adjuvant chemoradiation.
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Affiliation(s)
- Roshan S Prabhu
- Department of Radiation Oncology, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Sheela Hanasoge
- Department of Radiation Oncology, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Kelly R Magliocca
- Department of Pathology, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - William A Hall
- Department of Radiation Oncology, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Susie A Chen
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Kristin A Higgins
- Department of Radiation Oncology, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Mark El-Deiry
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - William Grist
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - J Trad Wadsworth
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Amy Y Chen
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jonathan J Beitler
- Department of Radiation Oncology, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
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28
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Lymph node ratio is of limited value for the decision-making process in the treatment of patients with laryngeal cancer. Eur Arch Otorhinolaryngol 2014; 272:453-61. [PMID: 24643852 DOI: 10.1007/s00405-014-2997-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/03/2014] [Indexed: 12/29/2022]
Abstract
The lymph node ratio (LNR) combines two types of information--about the extent of neck dissection and about the extent of the pathological examination of the specimen--and thus represents an interesting variable for risk assessment in patients with head and neck cancer. This retrospective study with data from January 1, 1980, to December 31, 2010, evaluates the utility of the LNR as a potential prognostic predictor in patients with laryngeal squamous cell carcinoma (LSCC). A total of 202 consecutive patients with regionally metastasized LSCC who underwent primary surgery with or without adjuvant treatment were included. The mean follow-up period was 4.4 years. The LNR was calculated as the ratio of positive nodes to the total number of nodes removed during neck dissection. Multivariate analysis was carried out. Peak values as averaged clusters of individual LNRs were registered at three points (LNR 0.05, 0.07, and 0.09). LNR 0.09 was a significant prognostic parameter in the Cox regression model (P = 0.007). Patients with an LNR > 0.09 had a hazard ratio of 2.065 for a disease-specific survival event in comparison with LNR < 0.09. The most accurate LNR for LSCC is expected to be located in the range of 0.08-0.1. The LNR seems to be of limited value for the decision-making process in the treatment of patients with LSCC, in comparison with other locations. Prospective trials will be required in order to allow evidence-based recommendations for treatment decisions based on the LNR.
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