Top

Published in:

01-06-2014 | Head and Neck Oncology

Is Lymph-node Ratio a Superior Predictor than Lymph Node Status for Recurrence-free and Overall Survival in Patients with Head and Neck Squamous Cell Carcinoma?

Authors: Sabine Reinisch, MD, Astrid Kruse, MD, DMD, Marius Bredell, MD, DMD, Heinz-Theo Lübbers, MD, DMD, Thomas Gander, MD, DMD, Martin Lanzer, MD, DMD

Published in: Annals of Surgical Oncology | Issue 6/2014

Abstract

Introduction

TNM status is questioned as an exact predictor of survival in different tumour entities. Recently, lymph node ratio (LNR) has been described as a predictor of survival in patients with HNSCC. The purpose of this study was to evaluate to which degree LNR could be used as a more accurate predictor than TNM staging?

Methods

A total of 291 patients, with a follow-up of at least 3 years, were analyzed using log-rank statistic, univariate and multivariate data analyzes, and p values, for prediction of lymph node ratio on overall and recurrence-free survival.

Results

Survival differed significantly if patients were stratified for LNR. Impact of LNR on survival was significantly different even in patients with extracapsular spread. Patients with pN0 had no survival benefit compared with patients with pN1 or higher with a LNR lower than 6 %.

Conclusions

LNR is a prognostic tool in patients with a lymph node status pN0–pN2b. LNR remained significant even in patients with extracapsular spread, contrary to TNM status. With LNR, stratification for high-risk patients (higher than 6 % LNR) can be evaluated easily. We would suggest using LNR in the clinical routine.

de Jong RJB, Hermans J, Molenaar J, Briaire JJ, le Cessie S. Prediction of survival in patients with head and neck cancer. Head Neck. 2001;23(9):718–24.CrossRef

Manikantan K, Sayed SI, Syrigos KN, et al. Challenges for the future modifications of the TNM staging system for head and neck cancer: case for a new computational model? Cancer Treatment Rev. 2009;35(7):639–44.CrossRef

Ebrahimi A, Clark JR, Zhang WJ, et al. Lymph node ratio as an independent prognostic factor in oral squamous cell carcinoma. Head Neck. 2011;33(9):1245–51.PubMedCrossRef

Gil Z, Carlson DL, Boyle JO, et al. Lymph node density is a significant predictor of outcome in patients with oral cancer. Cancer. 2009;115(24):5700–10.PubMedCrossRef

Shrime MG, Bachar G, Lea J, et al. Nodal ratio as an independent predictor of survival in squamous cell carcinoma of the oral cavity. Head Neck. 2009;31(11):1482–88.PubMedCrossRef

Lanzer M, Kruse A, Lübbers HT, Zemann W, Reinisch S. Lymph node ratio and capsule penetration as independent risk factors in head and neck squamous cell carcinoma. Head Neck Oncol. 2012;5(4):89–97.

Urban D, Gluck I, Pfeffer MR, Symon Z, Lawrence YR. Lymph node ratio predicts the benefit of post-operative radiotherapy in oral cavity cancer. Radiother Oncol. 2013;106(1):74–9.PubMedCrossRef

Robbins KT, Clayman G, Levine PA, et al. Neck dissection classification update—revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg. 2002;128(7):751–8.PubMedCrossRef

Lausen B, Schumacher M. Maximally selected rank statistics. Biometrics 1992;48(1):73–85.CrossRef

10.

Goldstein DP, Bachar GY, Lea J, et al. Outcomes of squamous cell cancer of the oral tongue managed at the Princess Margaret Hospital. Head Neck. 2013;35(5):632–41.PubMedCrossRef

11.

Shingaki S, Takada M, Sasai K, et al. Impact of lymph node metastasis on the pattern of failure and survival in oral carcinomas. Am J Surg. 2003;185(3):278–84.PubMedCrossRef

12.

Svatek R, Shariat SF. Re: lymph node density is superior to TNM nodal status in predicting disease-specific survival after radical cystectomy for bladder cancer: analysis of pooled data from MDACC and MSKCC. Eur Urol. 2008;54(3):690–1.PubMed

13.

Kassouf W, Agarwal PK, Herr HW, et al. Lymph node density is superior to TNM nodal status in predicting disease-specific survival after radical cystectomy for bladder cancer: analysis of pooled data from MDACC and MSKCC. J Clin Oncol. 2008;26(1):121–6.PubMedCrossRef

14.

Ooki A, Yamashita K, Kobayashi N, et al. Lymph node metastasis density and growth pattern as independent prognostic factors in advanced esophageal squamous cell carcinoma. World J Surg. 2007;31(11):2184–91.PubMedCrossRef

15.

Clayman GL, Frank DK. Selective neck dissection of anatomically appropriate levels is as efficacious as modified radical neck dissection for elective treatment of the clinically negative neck in patients with squamous cell carcinoma of the upper respiratory and digestive tracts. Arch Otolaryngol Head Neck Surg. 1998;124(3):348–52.PubMedCrossRef

16.

Patel RS, Clark JR, Gao K, O’Brien CJ. Effectiveness of selective neck dissection in the treatment of the clinically positive neck. Head Neck. 2008;30(9):1231–6.PubMedCrossRef

17.

Shepard PM, Olson J, Harari PM, Leverson G, Hartig GK. Therapeutic selective neck dissection outcomes. Otolaryngol Head Neck Surg. 2010;142(5):741–6.PubMedCrossRef

18.

Friedman M, Lim JW, Dickey W et al. Quantification of lymph nodes in selective neck dissection. Laryngoscope. 1999;109(3):368–70.PubMedCrossRef

19.

Beasley NJP, Prevo R, Banerji S, et al. Intratumoral lymphangiogenesis and lymph node metastasis in head and neck cancer. Cancer Res. 2002;62(5):1315–20.PubMed

20.

Stacker SA, Achen MG, Jussila L, Baldwin ME, Alitalo K. Lymphangiogenesis and cancer metastasis. Nat Rev Cancer. 2002;2(8):573–83.PubMedCrossRef

21.

Dias FL, Lima RA, Kligerman J, et al. Relevance of skip metastases for squamous cell carcinoma of the oral tongue and the floor of the mouth. Otolaryngol Head Neck Surg. 2006;134(3):460–5.PubMedCrossRef

22.

Myers JN, Greenberg JS, Mo V, Roberts D. Extracapsular spread: a significant predictor of treatment failure in patients with squamous cell carcinoma of the tongue. Cancer. 2001;92(12):3030–6.PubMedCrossRef

Title: Is Lymph-node Ratio a Superior Predictor than Lymph Node Status for Recurrence-free and Overall Survival in Patients with Head and Neck Squamous Cell Carcinoma?
Authors: Sabine Reinisch, MD
Astrid Kruse, MD, DMD
Marius Bredell, MD, DMD
Heinz-Theo Lübbers, MD, DMD
Thomas Gander, MD, DMD
Martin Lanzer, MD, DMD
Publication date: 01-06-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 6/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3634-5

At a glance: The STEP trials

Springer Medicine

Is Lymph-node Ratio a Superior Predictor than Lymph Node Status for Recurrence-free and Overall Survival in Patients with Head and Neck Squamous Cell Carcinoma?

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2014

Outcome Analysis of Expander/Implant Versus Microsurgical Abdominal Flap Breast Reconstruction: A Critical Study of 254 Cases

A Simple Tumor Load-Based Nomogram for Surgery in Patients with Colorectal Liver and Peritoneal Metastases

Impact of Inflammation–Metaplasia–Adenocarcinoma Sequence and Inflammatory Microenvironment in Esophageal Carcinogenesis Using Surgical Rat Models

Clinical Outcomes in Patients with Non-Diagnostic Thyroid Fine Needle Aspiration Cytology: Usefulness of the Thyroid Core Needle Biopsy

Pretreatment Clinical Mediastinal Nodal Bulk and Extent do not Influence Survival in N2-Positive Stage IIIA Non-small Cell Lung Cancer Patients Treated with Trimodality Therapy

Adjuvant Chemotherapy for Stage II Colon Cancer: Everyone Still Needs a Tailor