Which is the most suitable lymph node predictor for overall survival after primary surgery of head and neck cancer: pN, the number or the ratio of positive lymph nodes, or log odds?

2015 ◽  
Vol 142 (4) ◽  
pp. 885-893 ◽  
Author(s):  
Mehmet Metin Yildiz ◽  
Iver Petersen ◽  
Ekkehard Eigendorff ◽  
Peter Schlattmann ◽  
Orlando Guntinas-Lichius
Keyword(s):  
Overall Survival ◽  
Head And Neck Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Head And Neck ◽  
Neck Cancer ◽  
Primary Surgery ◽  
Log Odds ◽  
Positive Lymph Nodes

scholarly journals The log odds of positive neck lymph nodes is a superior lymph node predictor for overall survival in head and neck cancer: a population-based analysis in Germany

2021 ◽  
Author(s):  
Mussab Kouka ◽  
Elisa Al-Ahmar ◽  
Jens Büntzel ◽  
Holger Kaftan ◽  
Daniel Böger ◽  
...  
Keyword(s):  
Overall Survival ◽  
Head And Neck Cancer ◽  
Lymph Node ◽  
Head And Neck ◽  
Neck Cancer ◽  
Real Life ◽  
Stage Iv ◽  
Cancer Registries ◽  
Population Based ◽  
Log Odds

Abstract Background This population-based study investigated the influence of different lymph node (LN) classifications on overall survival (OS) in head and neck cancer (HNC). Methods 401 patients (median age: 57 years; 47% stage IV) of the Thuringian cancer registries with diagnosis of a primary HNC receiving a neck dissection (ND) in 2009 and 2010 were included. OS was assessed in relation to total number of LN removed, number of positive LN, LN ratio, and log odds of positive LN (LODDS). Results Mean number of LODDS was 0–0.96 ± 0.57. When limiting the multivariate analysis to TNM stage, only the UICC staging (stage IV: HR 9.218; 95% CI 2.721–31.224; p < 0.001) and LODDS >  – 1.0 (HR 2.120; 95% CI 1.129–3.982; p = 0.019) were independently associated with lower OS. Conclusion LODDS was an independent and superior predictor for OS in HNC in a population-based setting with representative real-life data.

Lymph node staging in extracranial head and neck cancer with FDG PET – appropriate uptake period and size-dependence of the results

2002 ◽  
Vol 41 (02) ◽  
pp. 108-113 ◽  
Author(s):  
Th. Klenzner ◽  
Th. Krause ◽  
M. Mix ◽  
U. H. Ross ◽  
E. Moser ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Head And Neck ◽  
Neck Cancer ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Lymph Node Staging ◽  
Cellular Activity ◽  
Plateau Phase

Summary Aim: Identification of a rationale for the appropriate uptake period for static clinical extracranial head and neck PET imaging and evaluation of the diagnostic accuracy of such an optimized FDG PET approach for lymph node staging in the head and neck region. Methods: In a subset of 5 patients, kinetic tumour studies were performed in order to identify the cellular activity plateau phase of FDG accumulation for head and neck cancer. Seventy-eight consecutive patients (11 women, 67 men; mean age ± SD: 55 ± 11 years; range, 36-78 years), presenting with histologically proven squamous cell carcinoma and sonographically detected lymph nodes in 86 neck sides, underwent clinically indicated FDG PET imaging. PET results were compared to those derived from histological examinations and follow-up imaging results after 6 months in order to calculate sensitivity and specificity for lymph node staging. Results: FDG kinetics in head and neck cancer indicate that the cellular activity plateau of FDG accumulation is reached after an uptake period of 90 min. Using this protocol metastatic involvement of neck sides with lymph nodes less than 1 cm in diameter was correctly identified with a sensitivity of 71.4% and a specificity of 92.3%. Sensitivity increased with the lymph node diameter (1.1-1.5 cm 83.3%, 1.6-2.0 cm 100%, > 2 cm 88.9%). Conclusion: The appropriate uptake period for static clinical extracranial head and neck PET imaging that allows measurements in the activity plateau phase is about 90 min. FDG PET may add some significant information regarding metastatic spread into regional lymph nodes.

Lymph Node Count From Neck Dissection Predicts Mortality in Head and Neck Cancer

2016 ◽  
Vol 34 (32) ◽  
pp. 3892-3897 ◽  
Author(s):  
Vasu Divi ◽  
Michelle M. Chen ◽  
Brian Nussenbaum ◽  
Kim F. Rhoads ◽  
Davud B. Sirjani ◽  
...  
Keyword(s):  
Overall Survival ◽  
Head And Neck Cancer ◽  
Lymph Node ◽  
Head And Neck ◽  
Neck Dissection ◽  
Neck Cancer ◽  
National Cancer Database ◽  
Node Negative ◽  
Lymph Node Count ◽  
Node Positive

Purpose Multiple smaller studies have demonstrated an association between overall survival and lymph node (LN) count from neck dissection in patients with head and neck cancer. This is a large cohort study to examine these associations by using a national cancer database. Patients and Methods The National Cancer Database was used to identify patients who underwent upfront nodal dissection for mucosal head and neck squamous cell carcinoma between 2004 and 2013. Patients were stratified by LN count into those with < 18 nodes and those with ≥ 18 nodes on the basis of prior work. A multivariable Cox proportional hazards regression model was constructed to predict hazard of mortality. Stratified models predicted hazard of mortality both for patients who were both node negative and node positive. Results There were 45,113 patients with ≥ 18 LNs and 18,865 patients with < 18 LNs examined. The < 18 LN group, compared with the ≥ 18 LN group, had more favorable tumor characteristics, with a lower proportion of T3 and T4 lesions (27.9% v 39.8%), fewer patients with positive nodes (46.6% v 60.5%), and lower rates of extracapsular extension (9.3% v 15.1%). Risk-adjusted Cox models predicting hazard of mortality by LN count showed an 18% increased hazard of death for patients with < 18 nodes examined (hazard ratio [HR] 1.18; 95% CI, 1.13 to 1.22). When stratified by clinical nodal stage, there was an increased hazard of death in both groups (node negative: HR, 1.24; 95% CI, 1.17 to 1.32; node positive: HR, 1.12; 95% CI, 1.05 to 1.19). Conclusion The results of our study demonstrate a significant overall survival advantage in both patients who are clinically node negative and node positive when ≥ 18 LNs are examined after neck dissection, which suggests that LN count is a potential quality metric for neck dissection.

Beyond Positive Margins and Extracapsular Extension: Evaluating the Utilization and Clinical Impact of Postoperative Chemoradiotherapy in Resected Locally Advanced Head and Neck Cancer

2017 ◽  
Vol 35 (14) ◽  
pp. 1550-1560 ◽  
Author(s):  
Daniel M. Trifiletti ◽  
Andrew Smith ◽  
Nandita Mitra ◽  
Surbhi Grover ◽  
John N. Lukens ◽  
...  
Keyword(s):  
Overall Survival ◽  
Head And Neck Cancer ◽  
Lymph Nodes ◽  
Head And Neck ◽  
Locally Advanced ◽  
Survival Outcomes ◽  
Advanced Head ◽  
Extracapsular Extension ◽  
Neck Disease ◽  
Positive Lymph Nodes

Purpose To examine recent utilization and survival outcomes associated with use of adjuvant chemoradiotherapy (CRT) for patients with resected locally advanced head and neck cancer (LAHNC) with negative surgical margins (SM negative) and no extracapsular extension (ECE). Materials and Methods We conducted a retrospective observational cohort study using the National Cancer Database evaluating patients diagnosed in 2004 to 2012 with AJCC stage III to IVB squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx treated with definitive surgery and adjuvant radiotherapy (RT) or CRT. We identified a subset of patients with SM negative and no ECE (n = 10,870). We determined factors associated with CRT use and examined overall survival of patients receiving CRT versus RT. We further evaluated survival outcomes by number of lymph nodes involved to assess whether this was associated with benefit from CRT. Results Among patients with resected LAHNC with SM negative and no ECE, 47% received adjuvant CRT. The use of CRT varied substantially according to several factors, including patient age, contralateral/bulky neck disease, increasing number of positive lymph nodes, and lower neck disease. CRT was associated with a statistically significant improvement in overall survival compared with RT alone (hazard ratio, 0.90; 95% CI, 0.86 to 0.94; P < .001). Survival benefits of CRT versus RT alone increased in patients with multiple positive lymph nodes. Conclusion The use of adjuvant CRT in patients with resected LAHNC with SM negative and no ECE is common. Substantial practice variation as well as the survival differences observed in this study support the conduct of additional research to guide personalized treatment approaches in this setting. The number of positive lymph nodes seems to be an appropriate selection factor for further investigation of CRT in such patients.

scholarly journals B-helper Neutrophils in Regional Lymph Nodes Correlate with Improved Prognosis in Patients with Head and Neck Cancer

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 3092
Author(s):  
Ekaterina Pylaeva ◽  
Irem Ozel ◽  
Anthony Squire ◽  
Ilona Spyra ◽  
Charlotte Wallner ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Lymph Nodes ◽  
B Cell ◽  
Head And Neck ◽  
Neck Cancer ◽  
Patient Survival ◽  
Helper Cell ◽  
Cell Phenotype ◽  
Regional Lymph Nodes ◽  
Patient Prognosis

The role of neutrophils during cancer formation and elimination is diverse. Here, for the first time, we investigate neutrophil helper cells (NBH), their influence on B cell activity in the regional lymph nodes (RLN) of head-and-neck cancer patients and the effect of this neutrophil/B cell interaction on patient prognosis. Circulating and RLN neutrophils of patients with stage I–IV head-and-neck squamous cell carcinoma were investigated with flow cytometry and qPCR. In addition, neutrophil/B cell co-localization in RLNs was evaluated using immunohistochemistry. B cell proliferation was assessed and correlated with the distance to neutrophils. Patient survival was evaluated. Neutrophils with the helper cell phenotype were identified in the RLN of HNC patients. B cells in close proximity to such NBH showed significantly higher proliferation rates, together with elevated activation-induced cytidine deaminase (AID) expression. Notably, patient survival was significantly higher in individuals with high NBH frequencies in the B follicles of RLNs. Neutrophils in RLN can support T cell-independent activation of the adaptive immune system through B cell stimulation, capturing helper cell phenotype character. The presence of such helper neutrophils in the RLNs of HNC patients positively correlates with patient prognosis.

Primary lung cancer after treatment of head and neck cancer without lymph node metastasis: Is there a role for autofluorescence bronchoscopy?

Lung Cancer ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 309-315 ◽  
Author(s):  
Pyng Lee ◽  
Remco de Bree ◽  
Hes A.P. Brokx ◽  
C. René Leemans ◽  
Pieter E. Postmus ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Head And Neck Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Head And Neck ◽  
Neck Cancer ◽  
Primary Lung Cancer ◽  
Node Metastasis ◽  
Autofluorescence Bronchoscopy
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