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

Sheppard, Sean C.; Frech, Lukas; Giger, Roland; Nisa, Lluís

doi:10.3390/cancers13092205

Cited by 16 publications

(9 citation statements)

References 46 publications

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“…The TLS total area was calculated as the sum of each TLS measured by the manual box selection function of the software Image Pro Plus (Figure 1A ). The minimum p ‐value method was used to further divide TLS+ into two groups, 19 , 20 the TLS low group (TLS L ) and the TLS high group (TLS H ). In our work, the cut‐off values of peritumor and intratumor are 109,941 pixels and 59,440 pixels, respectively.…”

Section: Methodsmentioning

confidence: 99%

Peritumor tertiary lymphoid structures are associated with infiltrating neutrophils and inferior prognosis in hepatocellular carcinoma

et al. 2022

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Background The positive prediction of prognosis and immunotherapy within tertiary lymphoid structure (TLS) in cancerous tissue has been well demonstrated, including liver cancer. However, the relationship between TLS and prognosis in the peritumoral region of hepatocellular carcinoma (HCC) has received less attention. Few studies on whether TLS, as a typical representative of acquired immune cell groups, is associated with innate immune cells. The aim of this paper was to identify the prognostic role of peritumor TLS in HCC and to simply explore the relationship with neutrophils infiltration. Methods This study included cancerous and paracancerous tissue from 170 patients after surgical resection of HCC. TLS was examined and identified by pathological H&E examination, and the impact on prognosis was further classified by determination of total TLS area. Immunohistochemical staining of CD15+ neutrophils was also performed on half of the cases. The obtained results were validated by external public database, as TLS has been widely shown to be tagged with 12 chemokines. Results In peritumoral tissue, the TLS− group had better overall survival (OS) and disease‐free survival (DFS) outcomes compared with the TLS+ group. On the contrary, the intratumor TLS+ group showed better DFS outcomes. When further investigating the relationship between TLS area distribution and DFS, progressively worse prognosis was only found in the peritumor region with increasing TLS density (TLS− vs. TLS L vs. TLS H ). In addition, neutrophil infiltration increased in parallel with TLS density in the peritumoral region, which was not observed in the intratumoral region. Conclusions TLS might have a dual prognostic role in different regions of HCC. The abundance of peritumoral TLS is an independent influence of DFS. The inconsistent correlation between neutrophils and corresponding TLS in different regions may indicate different pathways of immune aggregation and may serve as an explanation for the different prognosis of TLS, which needs to be specifically explored.

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Section: Methodsmentioning

confidence: 99%

Peritumor tertiary lymphoid structures are associated with infiltrating neutrophils and inferior prognosis in hepatocellular carcinoma

et al. 2022

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“…However, it remains unclear if there is a sex-dependent response difference regarding AT. The prognostic relevance of LNY and LNR has previously been addressed by several studies, 27,28 and the current American Society of Clinical Oncology guidelines state an LNY threshold of 18 as a parameter for an adequate neck dissection. 29 We showed that in the current study's cohort, low LNY was significantly associated with disease recurrence and mortality for patients without AT, while the optimal cutoff was 20 in both cases, independent of the extent of neck dissection, while a higher LNR was significantly associated with mortality, with a cutoff of 4.6% being identified in this study.…”

Section: Discussionmentioning

confidence: 99%

Oncologic Outcome in Advanced Oral Squamous Cell Carcinoma After Refusal of Recommended Adjuvant Therapy

Mrosk,

Doll,

Scheer

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceClinicians may be confronted with patients refusing recommended adjuvant therapy (AT) after the primary resection of an advanced oral squamous cell carcinoma (OSCC). However, for this tumor entity, data are lacking regarding the oncological outcomes and associated factors after refusal of AT.ObjectiveTo evaluate the difference in survival and disease recurrence for patients with and without recommended AT after resection of advanced OSCC.Design, Setting, and ParticipantsIn this single-center retrospective matched cohort study, patients with advanced OSCC who refused recommended AT between January 2010 and December 2021 were matched 1:1 according to Union for International Cancer Control tumor staging with patients who completed AT.ExposuresPatients with advanced OSCC who refused or completed recommended AT between 2010 and 2021.Main Outcomes and MeasuresThe primary outcome of this study was the comparison of overall survival (OS) and recurrence-free survival (RFS) between the 2 study groups.ResultsA total of 82 patients (mean [SD] age at time of surgery, 68.0 [11.3] years; 38 [46.3%] female, 44 [53.7%] male) with and without AT (41 per study group) were included in the analysis. Patients refusing AT developed more frequent disease recurrence than patients who completed AT (61.0% vs 26.8%; difference, 34.2%; odds ratio, 4.26; 95% CI, 1.68-10.84). In addition, patients who refused AT presented with lower 2-year OS (72.7% vs 88.6%; difference, 15.9%; 95% CI, 8.6%-40.6%) and much lower 2-year RFS (39.1% vs 74.2%; difference, 35.1%; 95% CI, 0.2%-70.5%). In the patient cohort who rejected AT, a worse OS was associated with female sex (48.6% vs 90.5%; difference, 41.9%; 95% CI, 0.6%-84.4%), pT1-2 category (57.1% vs 92.3%; difference, 35.2%; 95% CI, 3.3%-73.6%), and pN1 or higher category (61.2% vs 82.6%; difference, 21.4%; 95% CI, 14.1%-56.8%). Lower RFS was associated with female sex (37.9% vs 90.9%; difference, 53.0%; 95% CI, 8.0%-97.9%), advanced T category (pT3-4, 35.3% vs 80.0%; difference, 44.7%; 95% CI, 6.4%-95.3%), lymph node yield of 20 or greater (31.4% vs 80.6%; difference, 49.2%; 95% CI, 4.9%-93.4%), and lymph node ratio of less than 4.6% (36.6% vs 84.4%; difference, 47.8%; 95% CI, 1.8%-93.1%).Conclusions and RelevanceIn this cohort study of patients with advanced OSCC, refusal of AT was associated with worse oncological outcomes. The prevalence of disease recurrence during follow-up was 34% higher in patients who refused AT than in patients who completed AT. The results from this study may assist clinicians in guiding patients who are considering refusal of or withdrawal from AT.

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“…Microscopically, (C)RT induces the presence of atypical fibroblasts, swollen endothelial cells, and telangiectasia of thin-walled vessels. These changes manifest macroscopically and radiologically with the presence of tissue edema, fibrosis, and recurrent or chronic tissue inflammation, leading to possible erroneous interpretation of LN pathology [30][31][32] . In a study by our group, Sheppard et al demonstrated a significant reduction of LN yield in NDs of previously irradiated patients [33] .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of MRI and PET/CT for neck staging prior to salvage total laryngectomy

Galli¹,

Giger²,

Eliçin³

et al. 2022

J Cancer Metastasis Treat

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Aim: Lymph node (LN) metastases are associated with poor outcomes in patients with recurrent larynx squamous cell carcinoma (LSCC). Neck dissection (ND) is therefore commonly performed along with salvage total laryngectomy (STL). Here, we assess the rate of occult LN metastases and the diagnostic value of MRI and PET/CT for detecting them in recurrent LSCC. Methods: This retrospective study included patients with recurrent LSCC after primary (chemo)radiotherapy [(C)RT] who were re-staged by MRI and/or PET/CT and treated with STL and ND between 2004 and 2019. The histopathology of ND samples was used as the reference standard. Results: Forty-one patients were included. The prevalence of occult metastases in MRI-negative and PET/CT-negative neck nodes was between 3.2% and 6.1%. Negative predictive values of neck node re-staging were 93.9% for MRI, 96.8% for PET/CT, and 96.2% for MRI and PET/CT combined. Conclusion: Both MRI and PET/CT afforded good negative predictive values for nodal staging in patients with recurrent LSCC after (C)RT prior to STL. In selected patients, these radiological modalities, particularly PET/CT, could help to avoid unnecessary surgery to the neck and its associated morbidity.

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

Cited by 16 publications

References 46 publications

Peritumor tertiary lymphoid structures are associated with infiltrating neutrophils and inferior prognosis in hepatocellular carcinoma

Peritumor tertiary lymphoid structures are associated with infiltrating neutrophils and inferior prognosis in hepatocellular carcinoma

Oncologic Outcome in Advanced Oral Squamous Cell Carcinoma After Refusal of Recommended Adjuvant Therapy

Diagnostic accuracy of MRI and PET/CT for neck staging prior to salvage total laryngectomy

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