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High lymph node yield lowers mortality in oral cavity cancer
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Higher lymph nodal yield from elective neck dissection appeared associated with lower mortality among clinically node-negative patients with oral cavity squamous cell carcinoma, according to published findings.
Previous studies demonstrated a link between higher lymph node count to improved survival among patients with head and neck cancer and heterogenous clinical node presentations. However, the need for dissection among patients with clinically node-negative (cN0) oral cavity squamous cell carcinoma (OCSCC) remained unclear.
Chiaojung Jillian Tsai, MD, PhD, radiation oncologist at Memorial Sloan Kettering Cancer Center, and colleagues sought to determine survival impact of lymph node count. They used the National Cancer Data Base to identify 7,811 patients diagnosed with cN0 OCSCC between 2004 and 2012.
OS measured from 3 months after surgery to death or loss to follow-up served as the primary endpoint.
Results showed an OS of 92.2 months (95% CI, 87-96.2) over a median follow-up of 48.3 months (95% CI, 47.5-49.3).
The median node count was 23 (range, 1-90). Seventy-seven percent of patients did not have tumor in dissected lymph nodes (pN0).
Patients with fewer than 24 dissected nodes had a greater likelihood to be younger, as well as to have advanced clinical or pathologic categories, negative margins, undergone adjuvant therapy, had surgery at an academic facility and private insurance.
Multivariate analysis showed patients with more than 24 dissected nodes experienced longer OS than patients with 24 or fewer nodes (HR = 0.82; 95% CI, 0.75-0.88). The analysis further linked older age, comorbidity index, stage, and Medicare or Medicaid insurance with increased mortality.
Researchers also observed an association between adjuvant radiation and better OS.
“Because OCSCC is treated primarily by curative surgery, it is imperative to analyze this disease as a separate entity and account for tumor depth of invasion, a crucial prognostic factor,” the researchers wrote. “Furthermore, since locoregional recurrent OCSCC patients have poor salvage outcomes, it is appropriate to use a more stringent nodal yield than previously described.”
The ability to define a threshold for lymph node dissection that leads to improved survival may be an important step toward developing a metric system in the treatment of head and neck cancer, Jon Mallen-St. Clair, MD, PhD, clinical fellow in the department of head and neck surgery at University of California San Francisco, wrote in a related editorial.
“Until recently, no validated quality metrics for patients with head and neck cancer existed, limiting our ability to monitor quality of care,” Mallen-St. Clair wrote.
However, an association between lymph node yield and increased OS does not prove removing more lymph nodes is the direct cause of improved OS, he wrote. Rather, high-volume academic centers, negative margins and adherence to NCCN guidelines are associated with improved survival.
“These ... suggest that developing clinical best practices and improving guideline adherence may decrease variation in care and improve outcomes, and that developing a standard of care for a quality neck dissection may represent an important part of future clinical guidelines,” Mallen-St. Clair wrote. – by Melinda Stevens
Disclosures: The researchers and Mallen-St. Clair report no relevant financial disclosures.
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