Elective Neck Dissection for cT1‐4 N0M0 Head and Neck Verrucous Carcinoma

Abstract

ObjectiveTo investigate the survival benefit of elective neck dissection (END) over neck observation in cT1‐4 N0M0 head and neck verrucous carcinoma (HNVC).Study DesignRetrospective cohort study.SettingThe 2006 to 2017 National Cancer Database.MethodsPatients with surgically resected cT1‐4 N0M0 HNVC were selected. Linear, binary logistic, Kaplan‐Meier, and Cox proportional hazards regression models were utilized.ResultsOf 1015 patients satisfying inclusion criteria, 223 (22.0%) underwent END. The majority of patients were male (55.4%) and white (91.0%) with disease of the oral cavity (67.6%) classified as low grade (90.0%) and cT1‐2 (81.8%). The minority of ENDs (4.0%) detected occult nodal metastases. The rate of END increased from 2006 to 2017 for both cT1‐2 (16.3% vs 22.0%, p = .126, R2 = 0.405) and cT3‐4 (41.7% vs 70.0%, p = .424, R2 = 0.232) disease but these trends were not statistically significant. Independent predictors of undergoing END included treatment at an academic facility (adjusted odds ratio [aOR]: 1.75, 95% confidence interval [CI]: 1.19‐2.55), cT3‐4 disease (aOR: 3.31, 95% CI: 2.16‐5.07), and tumor diameter (aOR: 1.09, 95% CI: 1.01‐1.19) (p < 0.05). The 5‐year overall survival (OS) of patients treated with and without END was 71.3% and 70.6%, respectively (p = .661). END did not significantly reduce the 5‐year hazard of death (adjusted hazard ratio: 1.25, 95% CI: 0.91‐1.71, p = .172). END did not significantly improve 5‐year OS in univariate and multivariate analyses stratified by several patient, facility, tumor, and treatment characteristics.ConclusionEND does not confer an appreciable survival benefit in HNVC, even after stratifying univariate and multivariate analyses by several patient, facility, tumor, and treatment characteristics.Level of EvidenceLevel 4.

Patterns and Trends in Adjuvant Therapy for Major Salivary Gland Cancer

“…16,86 The NCDB does not reliably report medical comorbidities, tobacco use, history of neck irradiation, locoregional recurrence, adverse pathologic features, depth of invasion, facial nerve involvement, imaging studies, multidisciplinary tumor board recommendations, and quality of life data which should all be considered when determining the appropriateness of a potentially debilitating intervention such as adjuvant therapy. 44 Missed aRT is likely related to physician hesitancy in prescribing aggressive interventions, physicianpatient miscommunication, and inadequate social support, but variables necessary in making these inferences are also not encoded in the NCDB. 27 Our study reports adjuvant therapy as a binary outcome and is unable to consider interruptions in treatment and the extent of treatment completion.…”

“…16 Neck dissection was defined as the removal and examination of ≥10 lymph nodes, a validated threshold in head and neck cancer. 35,[44][45][46][47] aRT was defined as the delivery of therapeutic doses (44-70 Gy) of external beam radiation to the head and neck within 90 days of surgery. 11,16 aCRT was defined as the delivery of any chemotherapy, regardless of the type or number of agents, within 14 days of aRT initiation.…”

Surgical Resection Improves Overall Survival in cT4b Major Salivary Gland Cancer

“…Local tumor destruction, local tumor excision, partial removal, total removal, radical removal, and unspecified surgery were classified as surgical resection, as previously defined 6 . Neck dissection was defined as the removal and examination of $$\ge $$10 lymph nodes, a previously validated threshold 46‐48 . External beam radiation with volume in the head and neck was classified as RT.…”

“…6 Neck dissection was defined as the removal and examination of ≥10 lymph nodes, a previously validated threshold. [46][47][48] External beam radiation with volume in the head and neck was classified as RT. Definitive treatment included surgical resection + aRT alone, surgical resection + aCRT, RT with cumulative radiation dose between 66 and 80 Gy, and CRT with cumulative radiation dose between 66 and 80 Gy.…”

Extranodal extension in laryngeal squamous cell carcinoma

“…Neck dissection was defined as the removal and examination of 10 regional lymph nodes. 15 , 16 Patients with unknown grade, pathologic American Joint Committee on Cancer (AJCC) group stage, pTN classification, vital status, or survival time were excluded. Patients undergoing palliative care, salvage surgery, neoadjuvant therapy, or adjuvant chemotherapy alone were also excluded.…”