Clinical outcomes for patients presenting with N3 head and neck squamous cell carcinoma: Analysis of the National Cancer Database

Abstract

Background There is a paucity of data regarding head and neck squamous cell carcinomas and N3 nodal disease (N3 HNSCC). Methods Retrospective analysis of N3 HNSCC identified in the National Cancer Database was performed. Results We identified 4,867 N3 HNSCC patients treated with primary surgery or CRT. Propensity-adjusted median survival was 54.2 and 44.8 months for surgery and CRT, respectively (p = 0.06). Oropharyngeal primary subsite demonstrated a survival advantage with surgery versus CRT with propensity-adjusted median survivals of 86.0 and 61.9 months, respectively (p < 0.05). Conclusion Management of N3 HNSCC relies largely on chemoradiotherapy. N3 patients with non-oropharynx primary tumors exhibit 5-year overall survival approaching 30% independent of initial treatment modality. Patients with oropharynx primaries exhibit improved outcomes with surgery largely influenced by the HPV-negative subset. These data represent the most comprehensive analysis of N3 HNSCC outcomes and serve as a foundation for future research and clinical management.

Smoking and papillomavirus DNA in patients with p16‐positive N3 oropharyngeal squamous cell carcinoma

“…One of the most probable explications for this prognostic fluctuation between series with limited size is the rate of patients included with papillomavirus‐related disease. Actually, the rates of oropharyngeal localizations among series of N3 previously published range from 13% to 76%, depending on the country and the period . As expected, a recent analysis of the National Cancer Database for patients having N3 head and neck cancer showed a foreseeable trend towards better survival for patients with oropharyngeal squamous cell carcinoma (OPSCC) .…”

“…A few monocentric studies, as well as a recent pool analysis of 2 prospective randomized trials, have been previously published related to this very advanced neck staging that has been historically associated with very poor outcomes and a high rate of distant metastasis . However, the rates of oropharyngeal localizations among series of N3 have been ranging from 13% for Chan et al, to 76% for Adams et al, depending on the country and the date . Results from more recent studies are somehow very divergent regarding treatment outcomes specifically in OPSCC .…”

“…Actually, the rates of oropharyngeal localizations among series of N3 previously published range from 13% to 76%, depending on the country and the period . As expected, a recent analysis of the National Cancer Database for patients having N3 head and neck cancer showed a foreseeable trend towards better survival for patients with oropharyngeal squamous cell carcinoma (OPSCC) . In fact, the incidence of OPSCC is steadily rising in most of the developed countries, related to oncogenic human papillomavirus (HPV) infection, and HPV‐related OPSCC have demonstrated a comparatively better prognosis than tobacco‐driven lesions .…”

“…Among the patients with head and neck cancer, classification N3 has been associated with a dramatically poor prognosis . Patients with an N3 disease have been described to yield a low locoregional control, a high rate of distant metastases, low progression‐free survival (PFS), and low overall survival (OS) . However, published retrospective studies have shown large variations in rates of oncologic events in these patients to date.…”

“…However, published retrospective studies have shown large variations in rates of oncologic events in these patients to date. For example, the 3‐year OS rate ranged from 10.5% to 51.4%, depending on the series . One of the most probable explications for this prognostic fluctuation between series with limited size is the rate of patients included with papillomavirus‐related disease.…”