Joseph Zenga1, Vasu Divi2, Michael Stadler3, Becky Massey3, Bruce Campbell3, Monica Shukla4, Musaddiq Awan4, Christopher J Schultz4, Aditya Shreenivas5, Stuart Wong5, Ryan S Jackson6, Patrick Pipkorn6. 1. Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States. Electronic address: jyzenga@mcw.edu. 2. Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, United States. 3. Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States. 4. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States. 5. Department of Medical Oncology, Medical College of Wisconsin, Milwaukee, WI, United States. 6. Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, United States.
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.
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.
Authors: Ahmad A AlTuwaijri; Mohammed A Alessa; Alanoud A Abuhaimed; Reenad H Bedaiwi; Mohammad A Almayouf; Majed M Albarrak; Saleh F Aldhahri; Khalid H Al-Qahtani Journal: Saudi Med J Date: 2021-12 Impact factor: 1.422
Authors: Steffen Spoerl; Michael Gerken; Andreas Mamilos; René Fischer; Stefanie Wolf; Felix Nieberle; Christoph Klingelhöffer; Johannes K Meier; Silvia Spoerl; Tobias Ettl; Torsten E Reichert; Gerrit Spanier Journal: Clin Oral Investig Date: 2020-08-04 Impact factor: 3.573