Extranodal extension in laryngeal squamous cell carcinoma

Patel, Aman M.; Vedula, Sudeepti; Shaari, Ariana L.; Choudhry, Hannaan S.; Filimonov, Andrey

doi:10.1002/lio2.1232

Cited by 3 publications

(1 citation statement)

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“…END was defined as the removal and examination of ≥10 lymph nodes, a threshold validated by previous studies of the NCDB (Figure 2). 10,20,[33][34][35][36][37] Adjuvant radiotherapy (aRT) was defined as the receipt of therapeutic doses (44-70 Gy) of external beam radiation to the head and neck. The primary outcome of our study was 5-year overall survival (OS).…”

Section: Variablesmentioning

confidence: 99%

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

Patel,

Haleem,

Choudhry

et al. 2024

Otolaryngol.--head neck surg.

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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.

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Section: Variablesmentioning

confidence: 99%

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

Patel,

Haleem,

Choudhry

et al. 2024

Otolaryngol.--head neck surg.

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Primary site surgical resection in cM1 oral cavity squamous cell carcinoma

Patel,

Haleem,

Revercomb

et al. 2024

Laryngoscope Investig Oto

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ObjectiveTo investigate primary site surgical resection and overall survival (OS) in clinically distantly metastatic (cM1) oral cavity squamous cell carcinoma (OCSCC).MethodsThe 2006–2018 National Cancer Database was queried for patients presenting with cM1 OCSCC who underwent chemotherapy. Binary logistic, Kaplan–Meier, and multivariable Cox proportional hazards regression models were implemented.ResultsOf 278 patients satisfying inclusion criteria, 139 (50.0%) underwent chemotherapy alone, 80 (28.8%) underwent chemoradiotherapy, 25 (9.0%) underwent surgical resection + adjuvant chemotherapy, and 34 (12.2%) underwent surgical resection + adjuvant chemoradiotherapy; 5‐year OS was 9.4%, 15.2%, 8.3%, and 23.8%, respectively (p < .001). Compared with those not undergoing surgical resection, patients undergoing surgical resection underwent radiotherapy more frequently (57.6% vs. 36.5%) but multiple‐agent chemotherapy less frequently (40.7% vs. 74.4%) (p < .005). Twenty‐one (36.2%) patients undergoing surgical resection had positive surgical margins. Academic facility (adjusted odds ratio [aOR] 3.19, 95% CI 1.54–6.62) and Charlson‐Deyo comorbidity score ≥1 (aOR 2.82, 95% CI 1.25–6.32, p < .025) were associated with increased odds of undergoing surgical resection. Compared with chemotherapy alone, chemoradiotherapy (adjusted hazard ratio [aHR] 0.56, 95% CI 0.38–0.83) and surgical resection + adjuvant chemoradiotherapy (aHR 0.37, 95% CI 0.21–0.66) were associated with higher OS (p < .005). Immunotherapy (aHR 0.48, 95% CI 0.28–0.81, p = .006) was also independently associated with higher OS.ConclusionA minority of patients with cM1 OCSCC underwent primary site surgical resection. Despite the high rate of positive surgical margins, surgical resection + adjuvant chemoradiotherapy was associated with higher OS than chemotherapy alone, chemoradiotherapy, or surgical resection + adjuvant chemotherapy. Definitive local therapy may benefit select patients with cM1 OCSCC.Level of evidence: 4.

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