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Published in: European Archives of Oto-Rhino-Laryngology 3/2020

01-03-2020 | Neck Dissection | Laryngology

Lymph node density as a predictive factor for worse outcomes in laryngeal cancer

Authors: Sílvia Petrarolha, Rogério Dedivitis, Leandro Matos, Daniel Ramos, Marco Kulcsar

Published in: European Archives of Oto-Rhino-Laryngology | Issue 3/2020

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Abstract

Background

The lymph node density (LND) is the number of positive metastatic lymph nodes divided by the total number of dissected lymph nodes. The purpose of this study was to evaluate LND as a prognostic factor in patients with laryngeal squamous cell carcinoma (SCC).

Methods

The study included 186 patients with laryngeal SCC submitted to laryngeal surgical treatment with neck dissection between January 2009 and December 2016. Clinical–pathological variables were assessed, as well as the cut-off point for LND.

Results

LND value was calculated considering pN+ (LND = 0.060). The Kaplan–Meier curve (log-rank) related to cumulative survival demonstrated that patients with LND ≥ 0.060 had a higher mortality rate than those with LND < 0.060, presenting a more aggressive form of the disease, with earlier recurrence. However, only the LND ≥ 0.060 group had impact on both disease-free survival and overall survival.

Conclusion

The LND proved to be an important index in the prognostic evaluation of larynx SCC patients having a direct relationship with disease recurrence. Patients with LND ≥ 0.060 should be considered for adjuvant therapy.
Literature
1.
go back to reference Prabhu RS, Hanasoge S, Magliocca KR, Hall WA, Chen SA, Higgins KA, Saba NF, Deiry M, Grist W, Wadsworth JT, Chen AY, Beitler JJ (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(6):777–782PubMedCrossRef Prabhu RS, Hanasoge S, Magliocca KR, Hall WA, Chen SA, Higgins KA, Saba NF, Deiry M, Grist W, Wadsworth JT, Chen AY, Beitler JJ (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(6):777–782PubMedCrossRef
2.
go back to reference Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M, European Organization for Research and Treatment of Cancer Trial 22931 (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350(19):1945–1952PubMedCrossRef Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M, European Organization for Research and Treatment of Cancer Trial 22931 (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350(19):1945–1952PubMedCrossRef
3.
go back to reference Wang YL, Li DS, Wang Y, Wang ZY, Ji QH (2014) Lymph node ratio for postoperative staging of laryngeal squamous cell carcinoma with lymph node metastasis. PLoS ONE ONE 9(7):e87037CrossRef Wang YL, Li DS, Wang Y, Wang ZY, Ji QH (2014) Lymph node ratio for postoperative staging of laryngeal squamous cell carcinoma with lymph node metastasis. PLoS ONE ONE 9(7):e87037CrossRef
4.
go back to reference Ryu IS, Roh JL, Cho KJ, Choi SH, Nam SY, Kim SY (2015) Lymph node density as an independent predictor of cancer-specific mortality in patients with lymph node-positive laryngeal squamous cell carcinoma after laryngectomy. Head Neck 37(9):1319–1325PubMedCrossRef Ryu IS, Roh JL, Cho KJ, Choi SH, Nam SY, Kim SY (2015) Lymph node density as an independent predictor of cancer-specific mortality in patients with lymph node-positive laryngeal squamous cell carcinoma after laryngectomy. Head Neck 37(9):1319–1325PubMedCrossRef
5.
go back to reference Künzel 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(2):453–461PubMedCrossRef Künzel 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(2):453–461PubMedCrossRef
6.
go back to reference Shi X, Hu WP, Ji QH (2017) Development of comprehensive nomograms for evaluating overall and cancer-specific survival of laryngeal squamous cell carcinoma patients treated with neck dissection. Oncotarget 8(18):29722–29740PubMedPubMedCentralCrossRef Shi X, Hu WP, Ji QH (2017) Development of comprehensive nomograms for evaluating overall and cancer-specific survival of laryngeal squamous cell carcinoma patients treated with neck dissection. Oncotarget 8(18):29722–29740PubMedPubMedCentralCrossRef
7.
go back to reference Imre A, Pinar E, Dincer E, Ozkul Y, Aslan H, Songu M, Tatar B, Onur I, Ozturkcan S, Aladag I (2016) Lymph node density in node-positive laryngeal carcinoma: analysis of prognostic value for survival. Otolaryngol Head Neck Surg 155(5):797–804PubMedCrossRef Imre A, Pinar E, Dincer E, Ozkul Y, Aslan H, Songu M, Tatar B, Onur I, Ozturkcan S, Aladag I (2016) Lymph node density in node-positive laryngeal carcinoma: analysis of prognostic value for survival. Otolaryngol Head Neck Surg 155(5):797–804PubMedCrossRef
8.
go back to reference Dequanter D, Zouaoui-Boudjeltia K, Shahla M, Aubert C, Lothaire P (2016) Prognostic value of lymph node ratio for locoregional failure in patients with advanced head and neck cancers. Minerva Stomatol 65:39–42PubMed Dequanter D, Zouaoui-Boudjeltia K, Shahla M, Aubert C, Lothaire P (2016) Prognostic value of lymph node ratio for locoregional failure in patients with advanced head and neck cancers. Minerva Stomatol 65:39–42PubMed
9.
go back to reference Amar A, Rapoport A, Curioni OA, Dedivitis RA, Cernea CR, Brandão LG (2012) The density of metastatic lymph node as prognostic factor in squamous cell carcinoma of the tongue and floor of the mouth. Braz J Otorhinolaryngol 78(3):86–90PubMedCrossRef Amar A, Rapoport A, Curioni OA, Dedivitis RA, Cernea CR, Brandão LG (2012) The density of metastatic lymph node as prognostic factor in squamous cell carcinoma of the tongue and floor of the mouth. Braz J Otorhinolaryngol 78(3):86–90PubMedCrossRef
10.
go back to reference Ampil FL, Caldito G, Ghali GE, Baluna RG (2009) Does the negative node count affect disease-free survival in early-stage oral cavity cancer? J Oral Maxillofac Surg 67(11):2473–2475PubMedCrossRef Ampil FL, Caldito G, Ghali GE, Baluna RG (2009) Does the negative node count affect disease-free survival in early-stage oral cavity cancer? J Oral Maxillofac Surg 67(11):2473–2475PubMedCrossRef
11.
go back to reference American Joint Committee on Cancer (2017) AJCC cancer staging manual, 8th edn. Springer International Publishing, New York American Joint Committee on Cancer (2017) AJCC cancer staging manual, 8th edn. Springer International Publishing, New York
12.
go back to reference Reinisch S, Kruse A, Bredell M, Lübbers HT, Gander T, Lanzer M (2014) 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? Ann Surg Oncol 21(6):1912–1918PubMedCrossRef Reinisch S, Kruse A, Bredell M, Lübbers HT, Gander T, Lanzer M (2014) 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? Ann Surg Oncol 21(6):1912–1918PubMedCrossRef
13.
go back to reference Ebrahimi A, Clark JR, Zhang WJ, Elliott MS, Gao K, Milross CG, Shannon KF (2011) Lymph node ratio as an independent prognostic factor in oral squamous cell carcinoma. Head Neck 33(9):1245–1251PubMedCrossRef Ebrahimi A, Clark JR, Zhang WJ, Elliott MS, Gao K, Milross CG, Shannon KF (2011) Lymph node ratio as an independent prognostic factor in oral squamous cell carcinoma. Head Neck 33(9):1245–1251PubMedCrossRef
14.
go back to reference 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(24):5700–5710PubMedCrossRef 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(24):5700–5710PubMedCrossRef
15.
go back to reference Shrime MG, Bachar G, Lea J, Volling C, Ma C, Gullane PJ, Gilbert RW, Irish JC, Brown DH, Goldstein DP (2009) Nodal ratio as an independent predictor of survival in squamous cell carcinoma of the oral cavity. Head Neck 31(11):1482–1488PubMedCrossRef Shrime MG, Bachar G, Lea J, Volling C, Ma C, Gullane PJ, Gilbert RW, Irish JC, Brown DH, Goldstein DP (2009) Nodal ratio as an independent predictor of survival in squamous cell carcinoma of the oral cavity. Head Neck 31(11):1482–1488PubMedCrossRef
16.
go back to reference Kim SY, Nam SY, Choi SH, Cho KJ, Roh JL (2011) Prognostic value of lymph node density in node-positive patients with oral squamous cell carcinoma. Ann Surg Oncol 18(8):2310–2317PubMedCrossRef Kim SY, Nam SY, Choi SH, Cho KJ, Roh JL (2011) Prognostic value of lymph node density in node-positive patients with oral squamous cell carcinoma. Ann Surg Oncol 18(8):2310–2317PubMedCrossRef
17.
go back to reference de Ridder M, Marres CC, Smeele LE, van den Brekel MW, Hauptmann M, Balm AJ, van Velthuysen ML (2016) A critical evaluation of lymph node ratio in head and neck cancer. Virchows Arch 469(6):635–641PubMedCrossRef de Ridder M, Marres CC, Smeele LE, van den Brekel MW, Hauptmann M, Balm AJ, van Velthuysen ML (2016) A critical evaluation of lymph node ratio in head and neck cancer. Virchows Arch 469(6):635–641PubMedCrossRef
18.
go back to reference Jones TM, De M, Foran B, Harrington K, Mortimore S (2016) Laryngeal cancer: United Kingdom national multidisciplinary guidelines. J Laryngol Otol 130:S75–82PubMedPubMedCentralCrossRef Jones TM, De M, Foran B, Harrington K, Mortimore S (2016) Laryngeal cancer: United Kingdom national multidisciplinary guidelines. J Laryngol Otol 130:S75–82PubMedPubMedCentralCrossRef
Metadata
Title
Lymph node density as a predictive factor for worse outcomes in laryngeal cancer
Authors
Sílvia Petrarolha
Rogério Dedivitis
Leandro Matos
Daniel Ramos
Marco Kulcsar
Publication date
01-03-2020
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology / Issue 3/2020
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-020-05789-z

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ACKNOWLEDGEMENT TO REFEREES

Acknowledgement to referees 2019