Elective Neck Dissection in cT1‐4 N0M0 Head and Neck Basaloid Carcinoma

Abstract

ObjectiveTo investigate the survival benefit of elective neck dissection (END) over neck observation in surgically resected cT1‐4 N0M0 head and neck basaloid carcinoma (HNBC).Study DesignRetrospective cohort study.SettingThe 2006 to 2017 hospital‐based National Cancer Database.MethodsPatients with surgically resected cT1‐4 N0M0 HNBC were selected. Linear, binary logistic, Kaplan‐Meier, and Cox proportional hazards regression models were implemented.ResultsOf 857 patients satisfying inclusion criteria, the majority were male (77.0%) and white (88.1%) with disease of the oral cavity (21.5%) or oropharynx (42.9%) classified as high grade (76.9%) and cT1‐2 (72.9%). 389 (45.4%) patients underwent END. END utilization between 2006 and 2017 increased for cT1‐2 disease (33.3% vs 56.9%, R2 = .699) but remained relatively constant for cT3‐4 disease (66.7% vs 57.9%, R2 = .062). One‐hundred and fifteen (29.6%) ENDs detected occult nodal metastases (ONMs). The 5‐year overall survival (OS) of patients undergoing neck observation and END was 65.6% and 66.8%, respectively (P = .652). END was not associated with improved OS in survival analyses stratified by patient demographics, clinicopathologic features, and adjuvant therapy. Compared with surgery alone, adjuvant radiotherapy (adjusted hazard ratio: 0.74, 95% confidence interval [CI]: 0.57‐0.97, P = .031) was associated with improved OS. END (hazard ratio [HR]: 0.96, 95% CI: 0.71‐1.28, P = .770) and ONM (HR: 1.12, 95% CI: 0.78‐1.61, P = .551) were not associated with OS.ConclusionEND is performed in nearly half of patients with HNBC but is not associated with improved OS, even after stratifying survival analyses by patient demographics, clinicopathologic features, and adjuvant therapy. The rate of ONM approaching 30%, however, justifies inclusion of END in the surgical management of HNBC.