Diagnostic utility of central node necrosis in predicting extracapsular spread among oral cavity squamous cell carcinoma

Randall, Derrick R.; Lysack, John T.; Hudon, Marc E.; Guggisberg, Kelly; Nakoneshny, Steven C.; Matthews, T. Wayne; Dort, Joseph C.; Chandarana, Shamir

doi:10.1002/hed.23562

Cited by 29 publications

(24 citation statements)

References 21 publications

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“…Cervical nodal metastasis is very common and has a substantial effect on prognosis in patients with HNSCC. Zoumalan et al (13) and Randall et al (14) reported that CNN that was visible at preoperative CT was a useful indicator of extracapsular nodal spread, which was confirmed to be an important negative prognostic indicator in patients with HNSCC, with a sensitivity of 91%-95% and a negative predictive value of 88%-98% (15)(16)(17)(18)(19). These previous studies indirectly suggested that CNN may also be a negative prognostic factor in patients with HNSCC, including NPC; the results of our current study confirm this suggestion.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Cervical Nodal Necrosis in Nasopharyngeal Carcinoma: Analysis of 1800 Patients with Positive Cervical Nodal Metastasis at MR Imaging

Lan¹,

Huang²,

Chen³

et al. 2015

Radiology

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Purpose:To evaluate the prognostic value of cervical nodal necrosis (CNN) in patients with nasopharyngeal carcinoma (NPC) with magnetic resonance (MR) imaging. Materials and Methods:This was an institutional review board-approved retrospective study of 1800 patients with newly diagnosed stage T1, 4N1, 3M0 NPC who were treated with definitive radiation therapy, with or without chemotherapy, between January 2007 and December 2009; the requirement to obtain informed consent was waived. MR images were reviewed to assess lymph node status, and patients were divided into CNN and non-CNN groups. The overall survival, disease-free survival, regional relapse-free survival (RRFS), and distant metastasis-free survival (DMFS) were calculated with the Kaplan-Meier method, and differences were compared by using the log-rank test. Results:The incidence of CNN was 44.0% (792 of 1800). After the median follow-up period of 53 months, the 5-year overall survival, disease-free survival, RRFS, and DMFS rates of the CNN and non-CNN groups were 78.8% and 91.8%, 78.2% and 91.2%, 78.6% and 91.8%, and 78.4% and 91.6%, respectively (for all rates, P , .001). The distant metastasis rate was 18.7% (148 of 792) for the CNN group versus 4.6% (46 of 1008) for the non-CNN group (P , .01). Subgroup analysis revealed similar survival outcomes between stage N1 disease with CNN and stage N2 disease without CNN, stage N2 disease with CNN, and stage N3 disease regardless of CNN. CNN, T stage, N stage, age older than 44 years, and male sex were significant independent negative prognostic factors for overall survival, disease-free survival, RRFS, and DMFS. Conclusion:CNN is an independent negative prognostic factor in patients with NPC, and it may be appropriate to investigate whether N stage should be upgraded by one level in patients with CNN.q RSNA, 2015

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Cervical Nodal Necrosis in Nasopharyngeal Carcinoma: Analysis of 1800 Patients with Positive Cervical Nodal Metastasis at MR Imaging

Lan¹,

Huang²,

Chen³

et al. 2015

Radiology

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“…Some studies showed that rates of distant metastasis were higher in npc patients with retropharyngeal lymph node involvement. Zoumalan et al 14 and Randall et al 15 reported that cervical node necrosis visible on preoperative ct was a useful indicator of extracapsular nodal spread, which was confirmed to be an important negative prognostic indicator in patients with head-and-neck squamous cell carcinoma, with a sensitivity of 91%-95% and a negative predictive value of 88%-98% [16][17][18][19] . Those studies appear to suggest that snn might also be an unfavourable prognostic factor in patients with npc, and the results of the present study confirmed that suggestion.…”

Section: Discussionmentioning

confidence: 97%

Sentinel Node Necrosis Is a Negative Prognostic Factor in Patients with Nasopharyngeal Carcinoma: A Magnetic Resonance Imaging Study of 252 Patients

Wei

et al. 2017

Current Oncology

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PurposeWe explored the patterns of sentinel node metastasis and investigated the prognostic value of sentinel node necrosis (snn) in patients with nasopharyngeal carcinoma (npc), based on magnetic resonance imaging (mri).Methods This retrospective study enrolled 252 patients at our institution who had metastatic lymph nodes from biopsy-confirmed npc and who were treated with definitive radiation therapy, with or without chemotherapy. All participants underwent mri before treatment, and the resulting images were reviewed to evaluate lymph node status. The patients were divided into snn and non-snn groups. Overall survival (os), tumour-free survival (tfs), regional relapse-free survival (rrfs), and distant metastasis-free survival (dmfs) were calculated by the Kaplan-Meier method, and differences were compared using the log-rank test. Factors predictive of outcome were determined by univariate and multivariate analysis. ResultsOf the 252 patients, 189 (75%) had retropharyngeal lymph node metastasis, and 189 (75%) had level iia or iib lymph node necrosis. The incidence of snn was 43.4% (91 of 210 patients with lymph node metastasis or necrosis, or both). After a median follow-up of 54 months, the 5-year rates of os, tfs, rrfs, and dmfs in the snn and non-snn groups were, respectively, 79. 4% and 95.3%, 73.5% and 93.3%, 80.4% and 96.6%, and 75.5% and 95.3% (all p < 0.01). Age greater than 40 years, snn, T stage, and N stage were significant independent negative prognostic factors for os, tfs, rrfs, and dmfs.Conclusions Metastatic retropharyngeal lymph nodes and necrotic level ii nodes both seem to act as sentinels.Sentinel node necrosis is an negative prognostic factor in patients with npc. Patients with snn have a worse prognosis.

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“…Lymph node central necrosis, viewed by CT preoperatively, was noted to be an indicator for extracapsular spread, while lymph node diameter was not influential 27,28. However, a study by King et al17 showed that MRI was at par with CT in the detection of CNN with similar diagnostic accuracies and sensitivities (MRI: 91%–99% accuracy and 93% sensitivity; CT: 92%–99% accuracy and 91% sensitivity).…”

Section: Discussionmentioning

confidence: 99%

Cervical nodal necrosis is an independent survival predictor in nasopharyngeal carcinoma: an observational cohort study

Luo¹,

Ren²,

Zhou³

et al. 2016

OTT

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PurposeMost nasopharyngeal carcinoma (NPC) patients present with locoregionally advanced disease at the time of diagnosis; however, there is a lack of consensus on specific prognostic factors potentially improving overall survival, especially in late-stage disease. Herein, we conducted a retrospective study to evaluate various potential prognostic factors in order to provide useful information for clinical treatment of T3/T4-stage NPC.Patients and methodsA total of 189 previously untreated NPC patients were enrolled in the current study. All patients received intensity-modulated radiotherapy. Survival, death, relapse-free survival (both local and regional), and metastasis were recorded during follow-up. Factors affecting patient survival were assessed by using univariate and multivariate analyses.ResultsThe median follow-up time was 69 months. The 5-year local-regional recurrence-free survival, distant metastasis-free survival, progression-free survival (PFS), and overall survival (OS) of the entire group were 89.8%, 71.5%, 66.3%, and 68.9%, respectively. Univariate analysis revealed significant differences in the 5-year PFS (58.5% vs 72.5%, P=0.015) and OS (59.5% vs 75.8%, P=0.033) rates of patients with and without cervical nodal necrosis (CNN). Subgroup analyses revealed that CNN was associated with poorer distant metastasis-free survival and PFS among patients with N2 stage (P=0.046 and P=0.005) and with poorer PFS among patients with T3 or III stage (all P=0.022). Multivariate analysis revealed CNN to be an independent prognostic factor for PFS and OS (PFS: adjusted hazard ratio, 1.860; 95% CI: 1.134–3.051; P=0.014; OS: adjusted hazard ratio, 1.754; 95% CI: 1.061–2.899; P=0.028).ConclusionCNN is a potential independent negative prognostic factor in NPC patients. Our results suggest that stratification of NPC patients based on their CNN status should be considered as part of NPC disease management.

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Diagnostic utility of central node necrosis in predicting extracapsular spread among oral cavity squamous cell carcinoma

Abstract: Our findings suggest that central node necrosis on preoperative CT scans is strongly associated with the presence of ECS.

Cited by 29 publications

References 21 publications

Prognostic Value of Cervical Nodal Necrosis in Nasopharyngeal Carcinoma: Analysis of 1800 Patients with Positive Cervical Nodal Metastasis at MR Imaging

Prognostic Value of Cervical Nodal Necrosis in Nasopharyngeal Carcinoma: Analysis of 1800 Patients with Positive Cervical Nodal Metastasis at MR Imaging

Sentinel Node Necrosis Is a Negative Prognostic Factor in Patients with Nasopharyngeal Carcinoma: A Magnetic Resonance Imaging Study of 252 Patients

Cervical nodal necrosis is an independent survival predictor in nasopharyngeal carcinoma: an observational cohort study

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