Occult Lymph Node Metastasis in Early‐Stage Glottic Cancer in the National Cancer Database

Abstract

Objectives: Early-stage glottic cancer (cT1-T2 cN0) may be treated by primary surgery or radiation. Elective treatment of the neck in clinically N0 disease is usually not performed due to low rates of regional lymph node metastasis. This study examines the role of elective neck dissection (END) and rate of occult nodal metastasis in cT1-T2 cN0 glottic cancer treated with primary surgery. Study Design: Retrospective cohort study. Methods: The National Cancer Database was used to identify patients treated for early-stage glottic cancer. Demographic variables, disease characteristics, and overall survival were compared between the subgroups of patients who did and did not receive END. Factors predictive of occult lymph node metastasis were also identified using a multivariate logistic regression model. Results: Thirty-eight percent of the 991 patients in this cohort underwent END. Younger age, treatment at an academic facility, advanced T-stage, and higher tumor grade were associated with receiving END. Sixteen percent of the 372 patients undergoing END had occult nodal metastasis. Higher tumor histopathologic grade was associated with occult metastasis (P = .004). While undergoing END did not affect significantly survival, those with occult metastasis had poorer survival (P < .001). Conclusions: END should be considered in cT1-T2 N0 glottic cancers with poorly differentiated or undifferentiated tumor histopathology. While END itself may not improve overall survival, identification of occult nodal metastasis is an important finding for prognostication.

Management of clinically node‐negative glottic squamous cell carcinoma patients according to risk‐scoring model for occult lymph node metastases

“…Existing literature has compared the two approaches, negative neck in patients with early stage GSCC is usually not recommended. 20 21 ; two other studies also found that none of the patients with early stage glottic carcinomas showed occult LNM in their series. 22,23 In our research, neck metastasis was proved to be present at initial diagnosis in 20 (2.2%) cases among all T1-T2 GSCC patients.…”

“…Regardless of the primary treatment option, prophylactic intervention of the clinically negative neck in patients with early stage GSCC is usually not recommended. 20 Pinilla et al and Howell‐Burke et al reported an occult neck involvement rate of 2.3% and 4.3% in clinical T2N0 GSCC patients, respectively 21 ; two other studies also found that none of the patients with early stage glottic carcinomas showed occult LNM in their series. 22 , 23 In our research, neck metastasis was proved to be present at initial diagnosis in 20 (2.2%) cases among all T1‐T2 GSCC patients.…”

“…Existing literature has compared the two approaches, 2,18,19 but there is little evidence definitively favoring one treatment, making both of the two approaches acceptable options. Regardless of the primary treatment option, prophylactic intervention of the clinically negative neck in patients with early stage GSCC is usually not recommended 20 . Pinilla et al and Howell‐Burke et al reported an occult neck involvement rate of 2.3% and 4.3% in clinical T2N0 GSCC patients, respectively 21 ; two other studies also found that none of the patients with early stage glottic carcinomas showed occult LNM in their series 22,23 .…”

Impact of lymph node ratio and number of lymph node metastases on survival and recurrence in laryngeal squamous cell carcinoma

“…The laryngeal subsites (supraglottis, glottis, and subglottis) show marked differences in terms of the risk of lymph node metastasis 6,7 . Malignant tumors of supraglottic origin have a greater tendency for locoregional involvement; the percentage of lymph node metastases identified in exclusively glottic or subglottic carcinomas is less pronounced 8,9 . The subsite of origin of the tumor is one of the factors that determine the behavior of laryngeal neoplasia.…”

Márgenes histopatológicos positivos: ¿se relacionan siempre con recidiva tumoral en carcinoma glótico temprano?

“…La localización más habitual es en la glotis, seguida por la supraglotis (aproximadamente el 30 %); las neoplasias que se originan en la subglotis o que debutan como masas transglóticas son relativamente raras (1). La ubicación en la glotis confiere un mejor pronóstico respecto a la supraglotis o a la subglotis, dado que es una zona sin ganglios linfáticos y con escasos canales linfáticos, razón por la cual se asocia a una tasa relativamente baja de metástasis a través de esta vía (8)(9)(10). Las metástasis ocurren con más frecuencia cuando hay compromiso de la comisura anterior o diseminación generalizada en la glotis (11).…”