Prognostic Value of Metastatic Nodal Volume and Lymph Node Ratio in Patients with Cervical Lymph Node Metastases from an Unknown Primary Tumor

Abstract

Objective: The presence of metastatic cervical lymph nodes (MCNs) is an unfavorable prognostic factor in head and neck cancer. The total volume of MCNs (MNV) and the lymph node ratio (LNR) may be superior to conventional nodal staging in cervical metastasis from an unknown primary tumor (CUP). We evaluated the prognostic value of MNV and LNR in CUP patients. Methods: Thirty-nine patients with CUP who underwent surgery plus postoperative radiotherapy were reviewed. MNV was measured by preoperative computed tomography and LNR was determined using neck dissection samples. The association of clinicopathologic factors, MNV, and LNR with disease-free survival (DFS) and overall survival (OS) was analyzed. Results: Five-year DFS and OS were 68.4 and 70.8%, respectively, for a median follow-up of 49 months. In multivariate analysis, MNV (>30 ml) was an independent prognostic factor for both DFS and OS (p = 0.004 and p < 0.001, respectively). LNR (>0.14) was identified as an independent predictive factor for DFS (p = 0.041). Conclusion: MNV and LNR are independent prognostic factors in patients with CUP and could facilitate the identification of high-risk patients requiring intensive treatment and surveillance.

Impact of the 8th edition of the UICC TNM classification on staging and survival in patients with neck metastases of unknown primary tumor

“…Similar results were demonstrated by Jensen et al [57], Schroeder et al [27] and Axelsson et al [64], whereas Tribius et al [55] and Dixon et al [65] did not find any survival difference. In contrast to some [1,2,27,[66][67][68] but in line with other reports [54,56] nodal stage did not have an impact on survival in our cohort. In all but one study [68] demonstrating a prognostic role of the extent of nodal disease in CUP patients the HPV-status of the tumor had not been determined.…”

“…In contrast to some [1,2,27,[66][67][68] but in line with other reports [54,56] nodal stage did not have an impact on survival in our cohort. In all but one study [68] demonstrating a prognostic role of the extent of nodal disease in CUP patients the HPV-status of the tumor had not been determined. In the report by Park et al [68] HPV-positivity was only analysed by in situ-hybridization possibly leading to false-negative results.…”

“…In all but one study [68] demonstrating a prognostic role of the extent of nodal disease in CUP patients the HPV-status of the tumor had not been determined. In the report by Park et al [68] HPV-positivity was only analysed by in situ-hybridization possibly leading to false-negative results. Other studies failed to demonstrate an association between nodal stage and prognosis in HPV-positive tumors [69].…”

Prognostic value of lymph node ratio in head and neck squamous cell carcinoma

“…The 28 studies included are listed in Table . The results are categorized per subsite of the head and neck when possible.…”

Resection and reconstruction of giant cervical metastatic cancer using a pectoralis major muscular flap transfer: A prospective study of 16 patients

“…Uncontrolled cervical tumors are the main cause of chemoradiotherapy failure and patient mortality in these cases. The surgical treatment of cervical lymph nodes by neck dissection produces relatively high control rates and can improve rates of patient survival (18,19). Therefore, radical neck dissection is particularly important for patients with giant cervical metastatic cancers that have invaded the skin and developed from unknown primary tumors.…”