Incidence of Occult Lymph Node Metastasis in Primary Larynx Squamous Cell Carcinoma, by Subsite, T Classification and Neck Level: A Systematic Review

Abstract

Background: Larynx cancer is a common site for tumors of the upper aerodigestive tract. In cases with a clinically negative neck, the indications for an elective neck treatment are still debated. The objective is to define the prevalence of occult metastasis based on the subsite of the primary tumor, T classification and neck node levels involved. Methods: All studies included provided the rate of occult metastases in cN0 larynx squamous cell carcinoma patients. The main outcome was the incidence of occult metastasis. The pooled incidence was calculated with random effects analysis. Results: 36 studies with 3803 patients fulfilled the criteria. The incidence of lymph node metastases for supraglottic and glottic tumors was 19.9% (95% CI 16.4–23.4) and 8.0% (95% CI 2.7–13.3), respectively. The incidence of occult metastasis for level I, level IV and level V was 2.4% (95% CI 0–6.1%), 2.0% (95% CI 0.9–3.1) and 0.4% (95% CI 0–1.0%), respectively. For all tumors, the incidence for sublevel IIB was 0.5% (95% CI 0–1.3). Conclusions: The incidence of occult lymph node metastasis is higher in supraglottic and T3–4 tumors. Level I and V and sublevel IIB should not be routinely included in the elective neck treatment of cN0 laryngeal cancer and, in addition, level IV should not be routinely included in cases of supraglottic tumors.

<p>Lymph Nodes Dissection in Elderly Patients with T3-T4 Laryngeal Cancer</p>

“…On multivariable logistic regression, tumor site, tumor size and histological grade were associated with significantly greater odds of lymph nodes metastasis. Consistent with most studies, supraglottic cancer was a risk factor for lymph node metastasis, 15,19,20 whose relative risk of lymph node metastasis was close to 3 times that of glottic cancer. For poorly differentiated laryngeal cancer, the possibility of lymph node metastasis was significantly higher than that of welldifferentiated cancer, 14,20 and the relative risk of lymph node metastasis was twice that of well-differentiated laryngeal cancer.…”

“…For patients with laryngeal cancer, the more advanced the T classification gets, the greater possibility of lymph node metastasis there is. [12][13][14][15] Positive cervical lymph nodes have a negative impact on the patient's prognosis, and LND for such patients can improve survival significantly. 16 Similarly, our study also showed that the survival of elderly patients with laryngeal cancer (including OS and CSS) with lymph node metastasis was significantly inferior to that of patients without metastasis.…”

Lymph Node Yield and Ratio in Selective and Modified Radical Neck Dissection in Head and Neck Cancer—Impact on Oncological Outcome

“…Lymph node metastases (LNMs) are common at the time of diagnosis in head and neck squamous cell carcinomas (HNSCCs), while the rate of occult LNMs is up to 20% in some subtypes of HNSCC [ 1 , 2 , 3 , 4 , 5 ]. The presence of LNMs bears a major prognostic influence, with an estimated 50% reduction in overall survival in nodal negative vs. nodal positive HPV-negative HNSCC [ 6 , 7 , 8 ].…”

The survival benefit of lymph node dissection in resected T1–2, cN0 supraglottic cancer: A population‐based propensity score matching analysis

“…Laryngeal cancer remains the second most common malignant tumor of the upper respiratory tract. 1 Supraglottic cancer (SC), which accounts for 30%-40% of patients with laryngeal cancers, is characterized by a high rate of lymph node metastases, even in earlystage tumors (T1-2). 2 The high lymph node metastasis rate contributes to a worse prognosis in SC than with glottic cancer.…”