Removal of 18 lymph nodes associated with improved OS in mucosal HNSCC
Removing at least 18 lymph nodes during neck dissections for head and neck squamous cell carcinoma was associated with improved survival and lower rates of local-regional failure, according to results of a study published in Cancer.
Thus, researchers suggest that the cutpoint be further studied as a potential measure of quality in neck dissections.
“Recent efforts have shown that for clinicians to begin to improve cancer care, multidisciplinary teams must first have a way to measure quality,” Vasu Divi, MD, of the department of otolaryngology, Stanford University, and colleagues wrote. “The lymph node count from neck dissection is one such potential metric, and, on the basis of the findings in this study, may deserve further evaluation.”
To determine how the number of lymph nodes counted during dissection correlates with OS, local-regional failure and distant metastasis, researchers analyzed 572 patients treated in two postoperative NRG Oncology Radiation Therapy Oncology Group (RTOG) studies — RTOG 9501 and RTOG 0234 — at a median follow-up of 8 years. They used a multivariate Cox model adjusted for demographic, tumor and lymph node data, and stratified by postoperative treatment group, according to the study.
Researchers found that the removal and identification of fewer than 18 lymph nodes during neck dissection was associated with poorer OS compared with the removal of 18 or more lymph nodes (HR = 1.38; 95% CI, 1.09-1.74; P = .007). Additionally, Divi and colleagues determined local-regional failure was significantly higher among patients who had fewer than 18 lymph nodes removed (HR = 1.46; 95% CI, 1.02-2.08; P = .04). However, the rate of distant metastasis was not higher among this group.
Despite their findings, researchers noted the association between the number of removed lymph nodes and survival “may not necessarily equate with causality.”
“Higher lymph node counts in patients cannot be separated from the structural and process-related aspects of a patient’s care. Patients who have higher lymph node counts may receive care in higher volume institutions, have better perioperative care, be treated by more experienced radiation oncologists and medical oncologists, or be treated at more integrated academic medical centers,” the researchers wrote.
They concluded that “lymph node counts should be further evaluated as a potential measure of quality in head and neck surgery,” based on their findings and data previously reported in the literature. – by Andy Polhamus
Disclosure: Divi reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.