Elective neck dissection versus observation in patients with head and neck cutaneous squamous cell carcinoma

Abstract

BACKGROUND:The survival benefit of elective neck dissection (END) for patients with cutaneous squamous cell carcinoma (cSCC) of the head and neck and no evidence of regional metastasis (cN0) has never been reported. The aim of this study was to determine the effect of END on patient survival. METHODS: The authors included patients with head and neck cSCC who had undergone primary surgery from 1995 to 2017. The primary end point was survival, and the secondary end points were the incidence of occult regional disease and regional disease control. To assess the impact of END on survival, the authors used multivariable Cox proportional hazards models with propensity score and matching techniques for internal validation. RESULTS: A total of 1111 patients presented with no evidence of nodal disease; 173 had END, and 938 were observed. Adjuvant radiotherapy to the neck was administered to 101 patients (9%). END resulted in a 5-year overall survival rate of 52%, whereas the rate was 63% in the observation group (P = .003 [log-rank]). The 5-year disease-free survival rate for patients undergoing END was similar to that for the observation group (73% vs 75%; P = .429). A multivariate regression model showed that the performance of END was not associated with improved rates of overall, disease-specific, or disease-free survival; similarly, among patients with advanced disease (T3-4), those who underwent END did not have improved survival rates. CONCLUSIONS: Among patients with cSCC of the head and neck, observation of the neck nodes resulted in noninferior survival rates in comparison with END at the time of primary surgery. Further studies are required to elucidate the role of END in patients with advanced disease. Cancer 2021;127:4413-4420.

Sentinel lymph node biopsy in high‐risk cutaneous squamous cell carcinoma of the head and neck: Systematic review and meta‐analysis

“…A recent retrospective case-control study showed that in patients with cSCCHN observation of the neck resulted in noninferior survival rates compared to END, even if a relatively high-rate of occult metastases (21%) may suggest a potential role of END in selected cases. 23 Elective treatment of the neck is not recommended by current clinical guidelines even in high-risk cSCCHN, 19 and low evidence can be extracted from the current literature. In this context, SLNB may represent a valuable treatment option to improve regional disease control, reducing surgical morbidity of END.…”

“…20 Elective neck dissection (END) is rarely performed in head and neck cSCC (cSCCHN), with heterogeneous occult metastases rate reported by previous studies. [21][22][23] Giuseppe Mercante and Armando De Virgilio contributed equally to this study.…”

“…Moreover, no clear benefit has been measured in terms of survival compared to clinical observation. 23 In this context, an alternative surgical option in clinically node negative high-risk cSCCHN is sentinel lymph node biopsy (SLNB), which potentially reduces the risks and morbidity associated with the more invasive END. SLNB has been validated as an accurate technique for the assessment of regional nodal basins in several cancers, such as cutaneous melanoma 24,25 and mucosal oral cavity tumors.…”

“…Even if a therapeutic neck dissection is recommended for clinically proven node metastases, the elective treatment of node negative tumors remains controversial 20 . Elective neck dissection (END) is rarely performed in head and neck cSCC (cSCCHN), with heterogeneous occult metastases rate reported by previous studies 21–23 . Moreover, no clear benefit has been measured in terms of survival compared to clinical observation 23 .…”

“…Elective neck dissection (END) is rarely performed in head and neck cSCC (cSCCHN), with heterogeneous occult metastases rate reported by previous studies 21–23 . Moreover, no clear benefit has been measured in terms of survival compared to clinical observation 23 . In this context, an alternative surgical option in clinically node negative high‐risk cSCCHN is sentinel lymph node biopsy (SLNB), which potentially reduces the risks and morbidity associated with the more invasive END.…”