Lymph node count from neck dissection predicts mortality in head and neck cancer

Vasu Divi, Michelle M. Chen, Brian Nussenbaum, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, Wendy Hara

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Abstract

Purpose Multiple smaller studies have demonstrated an association between overall survival and lymph node (LN) count from neck dissection in patients with head and neck cancer. This is a large cohort study to examine these associations by using a national cancer database. Patients and Methods The National Cancer Database was used to identify patients who underwent upfront nodal dissection for mucosal head and neck squamous cell carcinoma between 2004 and 2013. Patients were stratified by LN count into those with < 18 nodes and those with ≥ 18 nodes on the basis of prior work. A multivariable Cox proportional hazards regression model was constructed to predict hazard of mortality. Stratified models predicted hazard of mortality both for patients who were both node negative and node positive. Results There were 45,113 patients with ≥ 18 LNs and 18,865 patients with < 18 LNs examined. The , 18 LN group, compared with the ≥18 LN group, had more favorable tumor characteristics, with a lower proportion of T3 and T4 lesions (27.9% v 39.8%), fewer patients with positive nodes (46.6% v 60.5%), and lower rates of extracapsular extension (9.3% v 15.1%). Risk-adjusted Cox models predicting hazard of mortality by LN count showed an 18% increased hazard of death for patients with < 18 nodes examined (hazard ratio [HR] 1.18; 95% CI, 1.13 to 1.22). When stratified by clinical nodal stage, there was an increased hazard of death in both groups (node negative: HR, 1.24; 95% CI, 1.17 to 1.32; node positive: HR, 1.12; 95% CI, 1.05 to 1.19). Conclusion The results of our study demonstrate a significant overall survival advantage in both patients who are clinically node negative and node positive when≥18 LNs are examined after neck dissection, which suggests that LN count is a potential quality metric for neck dissection.

Original languageEnglish (US)
Pages (from-to)3892-3897
Number of pages6
JournalJournal of Clinical Oncology
Volume34
Issue number32
DOIs
StatePublished - Nov 10 2016

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Neck Dissection
Head and Neck Neoplasms
Lymph Nodes
Mortality
Proportional Hazards Models
Databases
Neoplasms
Survival
Dissection
Cohort Studies

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Divi, V., Chen, M. M., Nussenbaum, B., Rhoads, K. F., Sirjani, D. B., Holsinger, F. C., ... Hara, W. (2016). Lymph node count from neck dissection predicts mortality in head and neck cancer. Journal of Clinical Oncology, 34(32), 3892-3897. https://doi.org/10.1200/JCO.2016.67.3863

Lymph node count from neck dissection predicts mortality in head and neck cancer. / Divi, Vasu; Chen, Michelle M.; Nussenbaum, Brian; Rhoads, Kim F.; Sirjani, Davud B.; Holsinger, F. Christopher; Shah, Jennifer L.; Hara, Wendy.

In: Journal of Clinical Oncology, Vol. 34, No. 32, 10.11.2016, p. 3892-3897.

Research output: Contribution to journalArticle

Divi, V, Chen, MM, Nussenbaum, B, Rhoads, KF, Sirjani, DB, Holsinger, FC, Shah, JL & Hara, W 2016, 'Lymph node count from neck dissection predicts mortality in head and neck cancer', Journal of Clinical Oncology, vol. 34, no. 32, pp. 3892-3897. https://doi.org/10.1200/JCO.2016.67.3863
Divi V, Chen MM, Nussenbaum B, Rhoads KF, Sirjani DB, Holsinger FC et al. Lymph node count from neck dissection predicts mortality in head and neck cancer. Journal of Clinical Oncology. 2016 Nov 10;34(32):3892-3897. https://doi.org/10.1200/JCO.2016.67.3863
Divi, Vasu ; Chen, Michelle M. ; Nussenbaum, Brian ; Rhoads, Kim F. ; Sirjani, Davud B. ; Holsinger, F. Christopher ; Shah, Jennifer L. ; Hara, Wendy. / Lymph node count from neck dissection predicts mortality in head and neck cancer. In: Journal of Clinical Oncology. 2016 ; Vol. 34, No. 32. pp. 3892-3897.
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title = "Lymph node count from neck dissection predicts mortality in head and neck cancer",
abstract = "Purpose Multiple smaller studies have demonstrated an association between overall survival and lymph node (LN) count from neck dissection in patients with head and neck cancer. This is a large cohort study to examine these associations by using a national cancer database. Patients and Methods The National Cancer Database was used to identify patients who underwent upfront nodal dissection for mucosal head and neck squamous cell carcinoma between 2004 and 2013. Patients were stratified by LN count into those with < 18 nodes and those with ≥ 18 nodes on the basis of prior work. A multivariable Cox proportional hazards regression model was constructed to predict hazard of mortality. Stratified models predicted hazard of mortality both for patients who were both node negative and node positive. Results There were 45,113 patients with ≥ 18 LNs and 18,865 patients with < 18 LNs examined. The , 18 LN group, compared with the ≥18 LN group, had more favorable tumor characteristics, with a lower proportion of T3 and T4 lesions (27.9{\%} v 39.8{\%}), fewer patients with positive nodes (46.6{\%} v 60.5{\%}), and lower rates of extracapsular extension (9.3{\%} v 15.1{\%}). Risk-adjusted Cox models predicting hazard of mortality by LN count showed an 18{\%} increased hazard of death for patients with < 18 nodes examined (hazard ratio [HR] 1.18; 95{\%} CI, 1.13 to 1.22). When stratified by clinical nodal stage, there was an increased hazard of death in both groups (node negative: HR, 1.24; 95{\%} CI, 1.17 to 1.32; node positive: HR, 1.12; 95{\%} CI, 1.05 to 1.19). Conclusion The results of our study demonstrate a significant overall survival advantage in both patients who are clinically node negative and node positive when≥18 LNs are examined after neck dissection, which suggests that LN count is a potential quality metric for neck dissection.",
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T1 - Lymph node count from neck dissection predicts mortality in head and neck cancer

AU - Divi, Vasu

AU - Chen, Michelle M.

AU - Nussenbaum, Brian

AU - Rhoads, Kim F.

AU - Sirjani, Davud B.

AU - Holsinger, F. Christopher

AU - Shah, Jennifer L.

AU - Hara, Wendy

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N2 - Purpose Multiple smaller studies have demonstrated an association between overall survival and lymph node (LN) count from neck dissection in patients with head and neck cancer. This is a large cohort study to examine these associations by using a national cancer database. Patients and Methods The National Cancer Database was used to identify patients who underwent upfront nodal dissection for mucosal head and neck squamous cell carcinoma between 2004 and 2013. Patients were stratified by LN count into those with < 18 nodes and those with ≥ 18 nodes on the basis of prior work. A multivariable Cox proportional hazards regression model was constructed to predict hazard of mortality. Stratified models predicted hazard of mortality both for patients who were both node negative and node positive. Results There were 45,113 patients with ≥ 18 LNs and 18,865 patients with < 18 LNs examined. The , 18 LN group, compared with the ≥18 LN group, had more favorable tumor characteristics, with a lower proportion of T3 and T4 lesions (27.9% v 39.8%), fewer patients with positive nodes (46.6% v 60.5%), and lower rates of extracapsular extension (9.3% v 15.1%). Risk-adjusted Cox models predicting hazard of mortality by LN count showed an 18% increased hazard of death for patients with < 18 nodes examined (hazard ratio [HR] 1.18; 95% CI, 1.13 to 1.22). When stratified by clinical nodal stage, there was an increased hazard of death in both groups (node negative: HR, 1.24; 95% CI, 1.17 to 1.32; node positive: HR, 1.12; 95% CI, 1.05 to 1.19). Conclusion The results of our study demonstrate a significant overall survival advantage in both patients who are clinically node negative and node positive when≥18 LNs are examined after neck dissection, which suggests that LN count is a potential quality metric for neck dissection.

AB - Purpose Multiple smaller studies have demonstrated an association between overall survival and lymph node (LN) count from neck dissection in patients with head and neck cancer. This is a large cohort study to examine these associations by using a national cancer database. Patients and Methods The National Cancer Database was used to identify patients who underwent upfront nodal dissection for mucosal head and neck squamous cell carcinoma between 2004 and 2013. Patients were stratified by LN count into those with < 18 nodes and those with ≥ 18 nodes on the basis of prior work. A multivariable Cox proportional hazards regression model was constructed to predict hazard of mortality. Stratified models predicted hazard of mortality both for patients who were both node negative and node positive. Results There were 45,113 patients with ≥ 18 LNs and 18,865 patients with < 18 LNs examined. The , 18 LN group, compared with the ≥18 LN group, had more favorable tumor characteristics, with a lower proportion of T3 and T4 lesions (27.9% v 39.8%), fewer patients with positive nodes (46.6% v 60.5%), and lower rates of extracapsular extension (9.3% v 15.1%). Risk-adjusted Cox models predicting hazard of mortality by LN count showed an 18% increased hazard of death for patients with < 18 nodes examined (hazard ratio [HR] 1.18; 95% CI, 1.13 to 1.22). When stratified by clinical nodal stage, there was an increased hazard of death in both groups (node negative: HR, 1.24; 95% CI, 1.17 to 1.32; node positive: HR, 1.12; 95% CI, 1.05 to 1.19). Conclusion The results of our study demonstrate a significant overall survival advantage in both patients who are clinically node negative and node positive when≥18 LNs are examined after neck dissection, which suggests that LN count is a potential quality metric for neck dissection.

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