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Lymph node metastasis level may predict survival in HNSCC
Lymph node metastasis level may serve as an independent prognostic factor for patients with locally advanced head and neck squamous cell carcinoma, according to the results of a registry study.
“Data from small retrospective series indicated that level of lymph node metastasis could be associated with worse survival, but this had never been investigated in large population-based data sets,” William N. William, Jr., MD, assistant professor in the department of thoracic/head and neck oncology at The University of Texas MD Anderson Cancer Center, told HemOnc Today. “We sometimes utilize this information to make clinical decisions, and we reasoned that it would be important to have robust, comprehensive data to support these decisions.”
William and colleagues used the SEER registry to identify 14,499 patients with various forms of head and neck squamous cell carcinoma (HNSCC), including oral cavity cancer (n = 2,463), oropharyngeal cancer (8,567), laryngeal cancer (n = 2,332) and hypopharyngeal cancer (1,137). They used a multivariate Cox proportional hazards model to determine whether lymph node metastasis level served as an independent prognostic factor for survival.
Median follow-up was 1.75 years for patients with oral cavity cancer, 2.17 years for those with oropharyngeal cancer, 1.92 years for patients with laryngeal cancer and 1.67 years for those with hypopharyngeal cancer.
American Joint Committee on Cancer (AJCC) N classification and lymph node metastasis level significantly affected OS in patients with oral cavity cancer (P = .0008 for both), oropharyngeal cancer (P = .0357 for N classification; P < .0001 for metastasis level) and laryngeal cancer (P < .0001 for N classification; P = .0068 for metastasis level). The effect was not significant for patients with hypopharyngeal cancer.
The subclassification of AJCC N2-classified disease appeared significantly associated with OS among patients with oropharyngeal cancer (P < .0001) and laryngeal cancer (P = .012) but not patients with oral cavity or hypopharyngeal cancers.
Lymph node metastasis — whether primary, secondary or tertiary — appeared significantly associated with OS in patients with oral cavity (P = .0001), oropharyngeal (P = .0041) and laryngeal (P = .02) HNSCC.
Limitations identified by the researchers include the relatively short follow-up periods, the lack of information regarding treatment and pathology, the potential for misclassification of lymph node metastasis and the lack of data regarding HPV status.
“Discussions on a new tumor node metastasis classification are currently underway,” William said in an interview. “Our study also underscores the need to evaluate the effect of level of lymph node metastasis in HPV-positive vs. HPV-negative oropharynx cancers, as this information was not available in the dataset utilized. If the findings hold true for HPV-positive cancers, for example, this could be a simple way of identifying HPV-related malignancies that may have higher risk of recurrence or death.
“The next step of our research is to also identify if level of lymph node metastasis can predict for risk of distant metastases,” William added. “This information can support further studies of strategies that can reduce distant spread of head and neck cancers, such as induction chemotherapy, in specific, high-risk patient subgroups.” – by Cameron Kelsal
For more information:
William N. William Jr., MD, can be reached at wnwillia@mdanderson.org.
Disclosure: The NIH provided partial funding for this study. One researcher reports personal fees from Bristol-Myers Squibb, Pfizer and Roche outside the submitted work.