1

Introduction

Lymph node metastasis is a well-known negative prognostic parameter in the treatment of squamous cell carcinoma of the head and neck (SCCHN). The presence of positive lymph nodes can reduce overall survival (OS) by 50% . Moreover, the number of metastatic lymph nodes (NMLN) in neck dissection specimens has been proven to be an indication of the need for adjuvant radiotherapy after primary head and neck surgery.

Recent studies have emphasized the importance of ratio-based lymph node staging as a predictor of survival in such malignancies as gastric, breast, bladder, pancreatic, and colon cancer . The purpose of the present study was to determine the prognostic significance of the ratio between metastatic and examined lymph nodes to the survival rate of patients with metastatic SCCHN.

2

Materials and methods

We retrospectively reviewed the records of patients with head and neck carcinomas who were treated at Hacettepe University, Faculty of Medicine, Department of Otolaryngology. From our database, 142 of these patients who underwent neck dissection and had histologic evidence of cervical lymph node metastasis were included in this study. Patients with histologic subtypes other than squamous cell carcinoma were excluded. Patients treated with radiotherapy as the primary treatment modality were also excluded. Individual demographic and clinicopathologic data were collected, including tumor size, nodal stage, neck dissection type, and presence of extracapsular invasion. In addition, the number of dissected lymph nodes, the NMLN, and the ratio of metastatic lymph nodes (RMLN) were determined for each patient. Tumors were staged according to the American Joint Committee of Head and Neck Carcinomas 2002 Tumor-Nodes-Metastasis staging system.

Overall survival was defined as the time from the date of primary treatment to the last follow-up. Disease-free survival (DFS) was defined as the length of time after primary treatment during which a patient survived with no sign of disease. Recurrence, whether locoregional or distant, was confirmed histologically or clinically.

For analysis of the entire population, median NMLN and median RMLN were determined; and groups were stratified around these medians. The prognostic value of both lymph node statuses (NMLN and RMLN) to OS and DFS was compared. For statistical analysis of the results, SPSS version 16.0 software was used (SPSS Inc, Chicago, IL). Survival analyses were estimated with the Kaplan-Meier method. Survival curves were analyzed with the log-rank and Cox regression methods. Statistical significance was set at P less than .05.

2

Materials and methods

We retrospectively reviewed the records of patients with head and neck carcinomas who were treated at Hacettepe University, Faculty of Medicine, Department of Otolaryngology. From our database, 142 of these patients who underwent neck dissection and had histologic evidence of cervical lymph node metastasis were included in this study. Patients with histologic subtypes other than squamous cell carcinoma were excluded. Patients treated with radiotherapy as the primary treatment modality were also excluded. Individual demographic and clinicopathologic data were collected, including tumor size, nodal stage, neck dissection type, and presence of extracapsular invasion. In addition, the number of dissected lymph nodes, the NMLN, and the ratio of metastatic lymph nodes (RMLN) were determined for each patient. Tumors were staged according to the American Joint Committee of Head and Neck Carcinomas 2002 Tumor-Nodes-Metastasis staging system.

Overall survival was defined as the time from the date of primary treatment to the last follow-up. Disease-free survival (DFS) was defined as the length of time after primary treatment during which a patient survived with no sign of disease. Recurrence, whether locoregional or distant, was confirmed histologically or clinically.

For analysis of the entire population, median NMLN and median RMLN were determined; and groups were stratified around these medians. The prognostic value of both lymph node statuses (NMLN and RMLN) to OS and DFS was compared. For statistical analysis of the results, SPSS version 16.0 software was used (SPSS Inc, Chicago, IL). Survival analyses were estimated with the Kaplan-Meier method. Survival curves were analyzed with the log-rank and Cox regression methods. Statistical significance was set at P less than .05.

3

Results

In all, 142 patients from our database met the study’s inclusion criteria. Patient age ranged from 23 to 88 years (mean, 55 years). Table 1 summarizes patient sex, site of carcinoma, clinical tumor size and nodal stage, neck dissection type, mode of treatment, and presence of extracapsular spread.

Table 1

Baseline demographic and tumor data of the study population

	No. of patients	%
Sex
Female	26	18
Male	116	82
Site of carcinoma
Larynx	82	58
Hypopharynx	2	1
Oral cavity	48	34
Oropharynx	8	1
Skin	2	6
Clinical tumor stage
T1	15	11
T2	67	47
T3	36	25
T4	24	17
Clinical nodal stage
N0	61	43
N+	39	57
Treatment
Surgery	48	34
Surgery + radiotherapy	53	37
Surgery + chemoradiotherapy	36	25
Surgery + palliative chemoradiotherapy	5	4
Neck dissection
Selective	38	27
Modified radical	16	11
Radical	88	62
Extracapsular spread
Present	34	24
Absent	108	76

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

1. When the bell tolls on Bell’s palsy: finding occult malignancy in acute-onset facial paralysis
2. Epistaxis due to Wegener’s granulomatosis in a pediatric patient
3. Recurrent contralateral abducens nerve palsy in acute unilateral sphenoiditis
4. Radiologic appearance of chronic parapharyngeal Teflon granuloma

Stay updated, free articles. Join our Telegram channel

Join