Prognostic value of the nodal yield in elective neck dissections in patients with head and neck carcinomas

León, Xavier; Venegas, María del Prado; Casasayas, María; Rodríguez, C.; Neumann, Eduard; Holgado, Anna; Quer, Miquel

doi:10.1007/s00405-021-06819-0

Cited by 7 publications

(16 citation statements)

References 26 publications

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“…Many studies—single and multi‐institutional, retrospective and prospective, as well as randomized—have investigated how different cutoff values of LNY affect the survival outcomes of patients with OSCC. The cutoff values that have been tested in other studies vary between 12 and 36, although an LNY of 18 remains the cutoff value for cN0 that most studies have determined as being predictive for survival outcome 7–11,14,16,18,29–33 . This study is to date the largest to examine how LNY and LND affect survival outcome in Danish patients with OSCC.…”

Section: Discussionmentioning

confidence: 99%

“…The cutoff values that have been tested in other studies vary between 12 and 36, although an LNY of 18 remains the cutoff value for cN0 that most studies have determined as being predictive for survival outcome. [7][8][9][10][11]14,16,18,[29][30][31][32][33] This study is to date the largest to examine how LNY and LND affect survival outcome in Danish patients with OSCC. We did not find an LNY 21 or other cutoff values to affect OS or RFS in node-negative cases.…”

Section: Discussionmentioning

confidence: 99%

“…In a landmark study, Ebrahimi et al 7 found an LNY of at least 18 nodes prognostic for more favorable survival in patients with clinically node‐negative OSCC. Hereafter, several studies have confirmed an LNY cutoff value of 18 as a prognosticator for survival outcome 8–14 . Furthermore, several studies have shown that high LND is associated with poor prognosis in patients with OSCC 15–17 .…”

mentioning

confidence: 80%

“…Hereafter, several studies have confirmed an LNY cutoff value of 18 as a prognosticator for survival outcome. [8][9][10][11][12][13][14] Furthermore, several studies have shown that high LND is associated with poor prognosis in patients with OSCC. [15][16][17] In addition, an international multicenter consortium study determined the best cutoff value for LND to be 7%.…”

mentioning

confidence: 99%

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Prognostic Value of Lymph Node Yield, Lymph Node Density, and pN in Oral Cancer

Stampe

Jakobsen

Tvedskov

et al. 2022

Otolaryngol.--head neck surg.

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Objectives To investigate thresholds for lymph node yield (LNY), lymph node density (LND), and pN in patients with oral squamous cell carcinoma in relation to previous findings in the literature. Study Design Retrospective register-based study. Setting Copenhagen Oral Cavity Squamous Cell Carcinoma database. Methods Appropriate thresholds for LNY, LND, and pN were determined by areas under the curve and subsequently subjected to multivariate analysis. Five-year overall survival and 3-year recurrence-free survival were determined by Kaplan-Meier survival curves. Results In total, 413 patients diagnosed with oral squamous cell carcinoma were included. In the pN0 cohort, no superior/prognostic LNY cutoff values were detected. In the pN+ cohort, areas under the curve determined thresholds of LNY, LND, and pN to be 21 nodes, 5%, and 3 metastases, respectively. The 5-year overall survival was 52% for patients with LNY ≥21 vs 38% for patients with LNY <21 (hazard ratio [HR], 1.49; 95% CI, 1.05-2.11; P < .05), 60% for patients with LND ≤5% vs 38% for patients with LND >6% (HR, 1.63; 95% CI, 1.03-2.57; P < .05), and 43% for patients with pN <3 vs 26% for patients with pN ≥3 (HR, 1.40; 95% CI, 1.04-2.15; P < .05). Conclusions Increased nodal yield, decreased LND, and decreasing number of pN were associated with significantly improved survival outcomes. LNY might serve as a prognosticator of survival as well as a surgical quality indicator. LND may have implications as a tool in cancer staging and treatment planning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 80%

mentioning

confidence: 99%

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Prognostic Value of Lymph Node Yield, Lymph Node Density, and pN in Oral Cancer

Stampe

Jakobsen

Tvedskov

et al. 2022

Otolaryngol.--head neck surg.

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“…[2][3][4] For head and neck cancers, systematic reviews have identified an association between a minimum LNY of 18-25 and overall survival. [5][6][7] Particularly, a significant proportion of these studies used a cutoff of LNY ≥18, first identified by Ebrahimi et al by metaanalyzing a cohort treated between 1970 and 2011 at seven centers. 8 These findings were later confirmed by Divi et al using a large national cancer database.…”

Section: Introductionmentioning

confidence: 99%

Lymph node yield: Impact on oncologic outcomes in oral cavity cancer

Khalil,

Khoury,

Higgins

et al. 2024

Head & Neck

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BackgroundLymph node metastases are associated with poor prognosis in oral cavity squamous cell carcinoma (OCSCC). In other cancers, clinical guidelines on the number of lymph nodes removed during primary surgery, lymph node yield (LNY), exist. Here, we evaluated the prognostic capacity of LNY on regional failure, locoregional recurrence, and disease‐free survival (DFS) in patients with OCSCC treated by primary neck surgery.MethodsThis retrospective cohort study took place at Sunnybrook Health Sciences Centre in Toronto, Canada and involved a chart review of all adult patients with treatment‐naive OCSCC undergoing primary neck dissection. For each outcome, we first used the maximally selected rank statistics and an optimism‐corrected concordance to identify an optimal threshold of LNY. We then used a multivariable Cox proportional hazards model to assess the association between high LNY (>threshold) and each outcome.ResultsAmong the 579 patients with OCSCC receiving primary neck dissection, 61.7% (n = 357) were male with a mean age of 62.9 years (standard deviation: 13.1) at cancer diagnosis. When adjusting for sociodemographic and clinical factors, LNY >15 was significantly associated with improved DFS (adjusted HR [aHR]: 0.73, 95% CI: 0.54–0.98), locoregional recurrence (aHR: 0.68, 95% CI: 0.49–0.95), and regional failure (aHR: 0.61, 95% CI: 0.39–0.93).ConclusionsOur study findings suggested high LNY to be a strong independent predictor of various patient‐level quality of surgical care metrics. The optimal LNY we found (15) was lower than the conventionally recommended (18), which calls for further research to establish validity in practice.

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