Lymph Node Yield as a Predictor of Survival in Pathologically Node Negative Oral Cavity Carcinoma

Abstract

These data suggest that patients with oral SCC undergoing elective neck dissection may experience an overall survival benefit associated with greater lymph node yield. Mechanisms behind the demonstrated survival advantage are unknown. Larger nodal dissections may remove a greater burden of microscopic metastatic disease, diminishing the likelihood of recurrence. Lymph node yield may serve as an objective measure of the adequacy of lymphadenectomy.

Minimum lymph node yield in elective level I–III neck dissection

“…Cervical lymphadenectomy remains the gold standard for nodal staging in cN0 patients with high‐risk head and neck SCCA . The accuracy of surgical staging in the cN0 neck depends on the number of lymph nodes removed and the sensitivity of the pathological methods for detecting occult metastatic disease …”

“…Cytokeratin immunohistochemical analysis can detect a single epithelial cancer cell in a lymph node; several studies have demonstrated a wide detection rate of micrometastatic disease using this technique . Prognostic implications of micrometastatic disease are not fully understood, but recent studies suggest the increased detection of micrometastatic disease with higher LNY may account for improved overall survival …”

“…Ebrahimi et al concluded that LNY <18 was associated with reduced overall and disease‐specific survival in oral cavity SCCA . A recent study by Lemieux et al reported improved overall survival for patients with pathologically N0 (pN0) oral cavity SCCA with greater LNY . Our study focused on patients with cN0 SCCA of the head and neck who underwent specifically elective level I–III neck dissection.…”

“…Elective neck dissection is indicated in the clinically node negative (cN0) neck for those with 15% to 20% risk of cervical metastasis . Elective level I–III (supraomohyoid) neck dissection is indicated for the majority of oral cavity SCCA and select cutaneous SCCA with high‐risk features due to the significant risk of occult nodal disease . High‐risk features for cutaneous lesions include primary lesions with a diameter >2 cm; >4‐mm depth; involvement of the auricle; poorly differentiated grade; and microvascular, lymphatic, or perineural invasion .…”

Highlights from the Current Issue

“…4 The authors queried the SEER database over an 11-year period from 1988 to 2009 and identified a total of 4341 patients with oral cavity SCC who were determined to be pN0 after elective lymph node dissection. They then studied the number of lymph nodes removed and its impact on overall survival.…”