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01-09-2014 | Head and Neck Oncology

Minimum Nodal Yield in Oral Squamous Cell Carcinoma: Defining the Standard of Care in a Multicenter International Pooled Validation Study

Authors: Ardalan Ebrahimi, MBBS, MPH, Jonathan R. Clark, MBBS, BSc, MD, M. Amit, MD, MSc, T. C. Yen, MD, Chun-Ta Liao, MD, PhD, Luis P. Kowalski, MD, PhD, Matthias Kreppel, MD, PhD, Claudio R. Cernea, MD, Gideon Bachar, MD, Andrea Bolzoni Villaret, MD, Dan Fliss, MD, Eran Fridman, MD, K. T. Robbins, MD, Jatin P. Shah, MD, Snehal G. Patel, MD, Ziv Gil, MD, PhD

Published in: Annals of Surgical Oncology | Issue 9/2014

Abstract

Purpose

There is evidence to suggest that a nodal yield <18 is an independent prognostic factor in patients with clinically node negative (cN0) oral squamous cell carcinoma (SCC) treated with elective neck dissection (END). We sought to evaluate this hypothesis with external validation and to investigate for heterogeneity between institutions.

Patients and Methods

We analyzed pooled individual data from 1,567 patients treated at nine comprehensive cancer centers worldwide between 1970 and 2011. Nodal yield was assessed with Cox proportional hazard models, stratified by study center, and adjusted for age, sex, pathological T and N stage, margin status, extracapsular nodal spread, time period of primary treatment, and adjuvant therapy. Two-stage random-effects meta-analyses were used to investigate for heterogeneity between institutions.

Results

In multivariable analyses of patients undergoing selective neck dissection, nodal yield <18 was associated with reduced overall survival [hazard ratio (HR) 1.69; 95 % confidence interval (CI) 1.22–2.34; p = 0.002] and disease-specific survival (HR 1.88; 95 % CI 1.21–2.91; p = 0.005), and increased risk of locoregional recurrence (HR 1.53; 95 % CI 1.04–2.26; p = 0.032). Despite significant differences between institutions in terms of patient clinicopathological factors, nodal yield, and outcomes, random-effects meta-analysis demonstrated no evidence of heterogeneity between centers in regards to the impact of nodal yield on disease-specific survival (p = 0.663; I ² statistic = 0).

Conclusion

Our data confirm that nodal yield is a robust independent prognostic factor in patients undergoing END for cN0 oral SCC, and may be applied irrespective of the underlying patient population and treating institution. A minimum adequate lymphadenectomy in this setting should include at least 18 nodes.

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Title: Minimum Nodal Yield in Oral Squamous Cell Carcinoma: Defining the Standard of Care in a Multicenter International Pooled Validation Study
Authors: Ardalan Ebrahimi, MBBS, MPH
Jonathan R. Clark, MBBS, BSc, MD
M. Amit, MD, MSc
T. C. Yen, MD
Chun-Ta Liao, MD, PhD
Luis P. Kowalski, MD, PhD
Matthias Kreppel, MD, PhD
Claudio R. Cernea, MD
Gideon Bachar, MD
Andrea Bolzoni Villaret, MD
Dan Fliss, MD
Eran Fridman, MD
K. T. Robbins, MD
Jatin P. Shah, MD
Snehal G. Patel, MD
Ziv Gil, MD, PhD
Publication date: 01-09-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 9/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3702-x

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Minimum Nodal Yield in Oral Squamous Cell Carcinoma: Defining the Standard of Care in a Multicenter International Pooled Validation Study

Abstract

Purpose

Patients and Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Patients and Methods

Results

Conclusion

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