Lymph Node Count From Neck Dissection Predicts Mortality in Head and Neck Cancer

Abstract

Purpose Multiple smaller studies have demonstrated an association between overall survival and lymph node (LN) count from neck dissection in patients with head and neck cancer. This is a large cohort study to examine these associations by using a national cancer database. Patients and Methods The National Cancer Database was used to identify patients who underwent upfront nodal dissection for mucosal head and neck squamous cell carcinoma between 2004 and 2013. Patients were stratified by LN count into those with < 18 nodes and those with ≥ 18 nodes on the basis of prior work. A multivariable Cox proportional hazards regression model was constructed to predict hazard of mortality. Stratified models predicted hazard of mortality both for patients who were both node negative and node positive. Results There were 45,113 patients with ≥ 18 LNs and 18,865 patients with < 18 LNs examined. The < 18 LN group, compared with the ≥ 18 LN group, had more favorable tumor characteristics, with a lower proportion of T3 and T4 lesions (27.9% v 39.8%), fewer patients with positive nodes (46.6% v 60.5%), and lower rates of extracapsular extension (9.3% v 15.1%). Risk-adjusted Cox models predicting hazard of mortality by LN count showed an 18% increased hazard of death for patients with < 18 nodes examined (hazard ratio [HR] 1.18; 95% CI, 1.13 to 1.22). When stratified by clinical nodal stage, there was an increased hazard of death in both groups (node negative: HR, 1.24; 95% CI, 1.17 to 1.32; node positive: HR, 1.12; 95% CI, 1.05 to 1.19). Conclusion The results of our study demonstrate a significant overall survival advantage in both patients who are clinically node negative and node positive when ≥ 18 LNs are examined after neck dissection, which suggests that LN count is a potential quality metric for neck dissection.

Lymph node yield from neck dissection in HPV‐associated oropharyngeal cancer

“…Patients with unknown or negative HPV status were excluded. Patients with zero or one lymph node harvested were excluded because they were considered to have likely undergone excisional biopsy rather than a true attempt at a formal neck dissection . Patients with gross residual disease after surgery were excluded because these patients were considered to have undergone surgical debulking or biopsy without the intent of complete surgical resection.…”

HPV status in unknown primary head and neck cancer: Prognosis and treatment outcomes

“…The NCDB is a nationwide clinical surveillance resource data set that includes approximately 70% of all newly diagnosed malignancies in the United States from over 1,500 cancer programs, as previously described . The NCDB has been used in a number of studies to study treatment‐related outcomes in head and neck malignancies . This study was determined to be exempt from institutional review by the Yale Human Investigation Committee.…”

Patterns of Care in Adjuvant Therapy for Resected Oral Cavity Squamous Cell Cancer in Elderly Patients

“…Margins were considered positive if there was residual tumor, microscopic residual tumor, or macroscopic residual tumor at the surgical margins after resection of the primary tumor. We considered patients who were node negative or node positive without ECE as “ECE absent” and those who were node positive with ECE as “ECE present.” We categorized neck dissections based on the number of nodes dissected (<18 vs ≥18) as studies have shown that this lymph node count can potentially serve as a quality metric for neck dissection (12). We considered those patients who had 0 or 1 lymph nodes dissected as not having undergone neck dissection because these patients most likely had lymph node biopsy.…”