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Lymph node yield, depth of invasion, and survival in node-negative oral cavity cancer. Oral Oncol 2019 Nov;98:125-131

Date

10/07/2019

Pubmed ID

31586894

DOI

10.1016/j.oraloncology.2019.09.028

Scopus ID

2-s2.0-85072773115   15 Citations

Abstract

OBJECTIVE: To determine the effects of nodal yield on survival in early stage oral cavity squamous cell carcinoma (OCSCC) in the context of primary tumor depth of invasion (DOI).

MATERIALS AND METHODS: Patients with early-stage clinically node-negative OCSCC who underwent upfront surgery at the primary site were identified using the National Cancer Database between 2004 and 2015.

RESULTS: There were 3384 patients with <4 mm DOI and 1387 patients with ≥4 mm DOI identified. Management of the neck included observation (40%), END with <18 nodes harvested ± postoperative radiation (ND < 18, 16%), and END with ≥18 nodes harvest ± postoperative radiation (ND ≥ 18, 44%). When adjusted for relevant covariates, ND ≥ 18 demonstrated statistically significant improvements in overall survival for both DOI < 4 mm and ≥4 mm (DOI < 4 mm: HR 0.67, 95%CI 0.54-0.85; DOI ≥ 4 mm: HR 0.47, 95%CI 0.34-0.64). However, ND < 18 showed no significant difference from observation of the neck regardless of DOI (DOI < 4 mm: HR 0.82, 95%CI 0.63-1.07; DOI ≥ 4 mm: HR 0.72, 95%CI 0.51-1.03). Of patients undergoing END, the most significant factors associated with obtaining a nodal yield of 18 or more were age less than 40 years (HR 2.58, 95%CI 1.84-3.63) and treatment at an academic facility (HR 2.47, 95%CI 2.06-2.96).

CONCLUSIONS: END with 18 or more nodes is associated with improved survival outcomes in patients with early stage OCSCC regardless of DOI. END with less than 18 nodes, however, does not appear significantly different than observation of the neck alone. Achieving a lymph node yield of 18 or more is multifactorial and includes both patient and provider factors.

Author List

Zenga J, Divi V, Stadler M, Massey B, Campbell B, Shukla M, Awan M, Schultz CJ, Shreenivas A, Wong S, Jackson RS, Pipkorn P

Authors

Musaddiq J. Awan MD Assistant Professor in the Radiation Oncology department at Medical College of Wisconsin
Bruce H. Campbell MD Professor in the Otolaryngology department at Medical College of Wisconsin
Becky Massey MD Associate Professor in the Otolaryngology department at Medical College of Wisconsin
Christopher J. Schultz MD Chair, Professor in the Radiation Oncology department at Medical College of Wisconsin
Aditya Shreenivas MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Monica E. Shukla MD Associate Professor in the Radiation Oncology department at Medical College of Wisconsin
Michael Stadler MD Associate Dean, Chief Medical Officer, Associate P in the Medical College Physicians Administration department at Medical College of Wisconsin
Stuart J. Wong MD Center Director, Professor in the Medicine department at Medical College of Wisconsin
Joseph Zenga MD Assistant Professor in the Otolaryngology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Clinical Decision-Making
Combined Modality Therapy
Disease Management
Female
Humans
Lymph Node Excision
Lymph Nodes
Lymphatic Metastasis
Male
Middle Aged
Mouth Neoplasms
Neoplasm Invasiveness
Prognosis
Proportional Hazards Models