Abstract
ObjectiveThe aim of this study is to compare pre-therapeutic staging of the loco-regional lymphatic basin and subsequent surgical management in cN0 versus cN+ hypopharyngeal and laryngeal cancer patients.MethodsWe analyzed all hypopharyngeal and laryngeal carcinoma patients treated surgically at a single quaternary medical care and cancer center between 2004 and 2014. We established two groups for patients who underwent neck dissection comparing patients with a low LNR (lymph node ratio) to one with a high LNR. Regarding the cN0 cohort, elective neck dissection was evaluated as a secondary predictor variable. Comorbidities, such as anemia and renal insufficiency, were analyzed as potentially influencing disease-free (DFS) and overall survival (OS).ResultsA total of 310 patients (185 glottic and 125 supraglottic/hypopharyngeal carcinoma) were included. Pre-therapeutic neck MRI-/CT-scan and concomitant neck ultrasound revealed cN+ status in 144 patients resulting in a significant over-staging in 63 patients (44%) who were rated as being pN0 after histological examination. 166 patients were staged cN0 and 21 underwent elective neck dissection (11 local advanced glottic and 10 supraglottic/hypopharyngeal carcinoma). Two cN0 patients showed occult cervical lymph node metastases (10%). Furthermore, we could detect a significant negative impact of the LNR divided by the number of dissected lymph nodes and OS.ConclusionThe pre-therapeutic clinical evaluation of lymphatic outgrowth is over-staged. OS decreases with increasing LNR divided by the number of dissected lymph nodes. Renal insufficiency and anemia are significant negative factors, decreasing both OS and DFS.
Highlights
Cervical lymph node metastases are one of the most important factors regarding survival in HNSCC [12]
We aimed to investigate the influence of selected comorbidities such as initial anemia and renal insufficiency on overall survival (OS) following surgical treatment
We performed a retrospective analysis of all patients older than 18 years diagnosed with hypopharyngeal or laryngeal squamous cell carcinoma (SCC) and surgically treated between 2004 and 2014 at the University Medical Center Freiburg
Summary
Cervical lymph node metastases are one of the most important factors regarding survival in HNSCC (head and neck squamous cell carcinoma) [12]. Despite modern radiological and clinical diagnostic tools, occult lymph node metastases are still reported [12, 16, 33]. The incidence of elective neck dissection in patients with clinically negative lymph node status depends on the risk of regional metastasis according to localization, stage and size of the primary tumor [13, 17, 31, 32]. Supraglottic and subglottic carcinomas are reported to metastasize more often lymphatically than glottic carcinomas due to scant lymphatic drainage of the vocal folds [12]. Different authors recommended different therapy options mostly depending on local T-status, histopathological features such as lymphovascular invasion or grading and surgical possibilities for complete resection of the primaries: elective neck dissection (ND) with
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