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Journal of Cancer Research and Clinical Oncology

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01-04-2016 | Original Article – Clinical Oncology

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?

Authors: Mehmet Metin Yildiz, Iver Petersen, Ekkehard Eigendorff, Peter Schlattmann, Orlando Guntinas-Lichius

Published in: Journal of Cancer Research and Clinical Oncology | Issue 4/2016

Abstract

Purpose

To investigate the best lymph node (LN) metastasis predictor for overall survival (OS) in head neck cancer (HNC): pN classification, number of positive lymph nodes (PNOD), lymph node ratio (LNR), or log odds of positive lymph nodes (LODDS).

Methods

In total, 225 surgically treated HNC patients were evaluated for the different LN classifications and OS.

Results

Five-year OS was 71.8 %. Mean number of yielded LN and PNOD was 25.3 ± 16.7 and 2.7 ± 5.9, respectively. 64.8 % had a LNR > 0.10 and 64.4 % a LODDS > 10. In univariable analysis, multimodal therapy (p = 0.039), advanced pT (p < 0.0001), advanced UICC stage (p = 0.029), LNR > 0.10 (p = 0.049), and LODDS > −1.0 (p = 0.021) were associated with lower OS. In multivariable analysis, advanced pT [hazard ratio (HR) 2.194; 95 % confidence interval (CI) 1.294–3.722; p = 0.004] and LODDS > −1.0 (HR 1.634; 95 % CI 1.002–2.665; p = 0.059) remained independent predictors for lower OS.

Conclusions

It seems useful to analyze the prognostic significance of LODDS in other samples of HNC.

Argiris A, Karamouzis MV, Raben D, Ferris RL (2008) Head and neck cancer. Lancet 371:1695–1709CrossRefPubMed

Bernier J et al (2005) Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 27:843–850CrossRefPubMed

Brannan AG, Johnstone PA, Cooper J (2011) Extracapsular tumor extension in cervical lymph nodes: reconciling the literature and seer data. Head Neck 33:525–528. doi:10.1002/hed.21487 CrossRefPubMed

Burusapat C, Jarungroongruangchai W, Charoenpitakchai M (2015) Prognostic factors of cervical node status in head and neck squamous cell carcinoma. World J Surg Oncol 13:51. doi:10.1186/s12957-015-0460-6 CrossRefPubMedPubMedCentral

Chan AT, Grégoire V, Lefebvre JL, Licitra L, Hui EP, Leung SF, Felip E, EHNS–ESMO–ESTRO Guidelines Working Group (2012) Nasopharyngeal cancer: EHNS–ESMO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(Suppl 7):vii83–vii85CrossRefPubMed

Chen YL et al (2015) Prognostic influences of lymph node ratio in major cancers of Taiwan: a longitudinal study from a single cancer center. J Cancer Res Clin Oncol 141:333–343CrossRefPubMed

Ebrahimi A, Clark JR, Zhang WJ, Elliott MS, Gao K, Milross CG, Shannon KF (2011a) Lymph node ratio as an independent prognostic factor in oral squamous cell carcinoma. Head Neck 33:1245–1251CrossRefPubMed

Ebrahimi A, Zhang WJ, Gao K, Clark JR (2011b) Nodal yield and survival in oral squamous cancer: defining the standard of care. Cancer 117:2917–2925CrossRefPubMed

Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (2010) AJCC cancer staging manual. Springer, New York

Ghadjar P et al (2010) Quantitative analysis of extracapsular extension of metastatic lymph nodes and its significance in radiotherapy planning in head and neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 76:1127–1132CrossRefPubMed

Gil Z, Carlson DL, Boyle JO, Kraus DH, Shah JP, Shaha AR, Singh B, Wong RJ, Patel SG (2009) Lymph node density is a significant predictor of outcome in patients with oral cancer. Cancer 115:5700–5710CrossRefPubMed

Grégoire V, Lefebvre JL, Licitra L, Felip E, EHNS–ESMO–ESTRO Guidelines Working Group (2010) Squamous cell carcinoma of the head and neck: EHNS–ESMO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v184–v186CrossRefPubMed

Harari PM et al (2014) Postoperative chemoradiotherapy and cetuximab for high-risk squamous cell carcinoma of the head and neck: Radiation Therapy Oncology Group RTOG-0234. J Clin Oncol 32:2486–2495CrossRefPubMedPubMedCentral

Harrell FE Jr (2015) rms: regression modeling strategies. R package version 4.3-1. http://CRAN.R-project.org/package=rms

Harrell FE Jr, Lee KL, Mark DB (1996) Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15:361–387CrossRefPubMed

Hua YH, Hu QY, Piao YF, Tang Q, Fu ZF (2015) Effect of number and ratio of positive lymph nodes in hypopharyngeal cancer. Head Neck 37:111–116CrossRefPubMed

Kunzel J, Mantsopoulos K, Psychogios G, Agaimy A, Grundtner P, Koch M, Iro H (2015) Lymph node ratio is of limited value for the decision-making process in the treatment of patients with laryngeal cancer. Eur Arch Otorhinolaryngol 272:453–461. doi:10.1007/s00405-014-2997-3 CrossRefPubMed

Le Tourneau C, Velten M, Jung GM, Bronner G, Flesch H, Borel C (2005) Prognostic indicators for survival in head and neck squamous cell carcinomas: analysis of a series of 621 cases. Head Neck 27:801–808CrossRefPubMed

Lee CC, Ho HC, Su YC, Lee MS, Hung SK, Chen YL (2015) The prognostic ability of log odds of positive lymph nodes in oral cavity squamous cell carcinoma. Medicine 94:e1069. doi:10.1097/MD.0000000000001069 CrossRefPubMedPubMedCentral

Lewis JS Jr, Carpenter DH, Thorstad WL, Zhang Q, Haughey BH (2011) Extracapsular extension is a poor predictor of disease recurrence in surgically treated oropharyngeal squamous cell carcinoma. Mod Pathol 24:1413–1420CrossRefPubMedPubMedCentral

Marres CC, de Ridder M, Hegger I, van Velthuysen ML, Hauptmann M, Navran A, Balm AJ (2014) The influence of nodal yield in neck dissections on lymph node ratio in head and neck cancer. Oral Oncol 50:59–64CrossRefPubMed

Patel SG et al (2013) Lymph node density in oral cavity cancer: results of the International Consortium for Outcomes Research. Br J Cancer 109:2087–2095CrossRefPubMedPubMedCentral

Prabhu RS et al (2015) Lymph node ratio influence on risk of head and neck cancer locoregional recurrence after initial surgical resection: implications for adjuvant therapy. Head Neck 37:777–782CrossRefPubMed

Preuss SF, Klussmann JP, Wittekindt C, Damm M, Semrau R, Drebber U, Guntinas-Lichius O (2007) Long-term results of the combined modality therapy for advanced cervical metastatic head and neck squamous cell carcinoma. Eur J Surg Oncol 33:358–363CrossRefPubMed

Qiu MZ et al (2012) The tumor-log odds of positive lymph nodes-metastasis staging system, a promising new staging system for gastric cancer after D2 resection in China. PLoS ONE 7:e31736. doi:10.1371/journal.pone.0031736 CrossRefPubMedPubMedCentral

RC Team (2104) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

Royston P, Altman DG, Sauerbrei W (2006) Dichotomizing continuous predictors in multiple regression: a bad idea. Stat Med 25:127–141CrossRefPubMed

Shrime MG et al (2009) Nodal ratio as an independent predictor of survival in squamous cell carcinoma of the oral cavity. Head Neck 31:1482–1488CrossRefPubMed

Sobin LH, Gospodarowicz MK, Wittekind C (2010) TNM classification of malignant tumours. Blackwell, Oxford

Song YX et al (2011) Which is the most suitable classification for colorectal cancer, log odds, the number or the ratio of positive lymph nodes? PLoS ONE 6:e28937. doi:10.1371/journal.pone.0028937 CrossRefPubMedPubMedCentral

Stennert E, Kisner D, Jungehuelsing M, Guntinas-Lichius O, Schröder U, Eckel HE, Klussmann JP (2003) High incidence of lymph node metastasis in major salivary gland cancer. Arch Otolaryngol Head Neck Surg 129:720–723CrossRefPubMed

Sun Z et al (2010) Log odds of positive lymph nodes: a novel prognostic indicator superior to the number-based and the ratio-based N category for gastric cancer patients with R0 resection. Cancer 116:2571–2580CrossRefPubMed

Vaidya AM, Petruzzelli GJ, Clark J, Emami B (2001) Patterns of spread in recurrent head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg 125:393–396CrossRefPubMed

Vander Poorten V, Bradly PJ, Takes RP, Rinaldo A, Woolgar JA, Ferlito A (2012) Diagnosis and management of parotid carcinoma with a special focus on recent advances in molecular biology. Head Neck 34:429–440CrossRefPubMed

Vinh-Hung V et al (2004) Ratios of involved nodes in early breast cancer. Breast Cancer Res 6:R680–R688. doi:10.1186/bcr934 CrossRefPubMedPubMedCentral

Wang J, Hassett JM, Dayton MT, Kulaylat MN (2008) The prognostic superiority of log odds of positive lymph nodes in stage III colon cancer. J Gastrointest Surg 12:1790–1796CrossRefPubMed

Wittekind C, Compton C, Brierley J, Sobin LH (2012) TNM supplement: a commentary on uniform use. Wiley-Blackwell, Oxford

Title: 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?
Authors: Mehmet Metin Yildiz
Iver Petersen
Ekkehard Eigendorff
Peter Schlattmann
Orlando Guntinas-Lichius
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: Journal of Cancer Research and Clinical Oncology / Issue 4/2016
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-015-2104-1

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Abstract

Purpose

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Conclusions

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