title: Nodal yield of neck dissections and influence on outcome in laryngectomized patients.
abstract: The appropriate extent of neck dissection (ND) in head and neck squamous cell carcinoma (SCC) continues to be investigated. This study aimed to determine whether the extent of ND as measured by nodal yield (NY) is a prognostic factor in patients undergoing primary total laryngectomy (TL) for advanced laryngeal SCC. A retrospective review at a tertiary referral centre identified 54 patients who underwent TL with elective (n = 39, cN0) or therapeutic (n = 15, cN+) ND with curative intent between 2002 and 2014. Survival analysis was obtained via regression analysis, calculated for overall (OS) and disease-free survival (DFS). Stage-independent 5-year OS was 32.1 %. Mean NY was 18.67 (standard deviation 9.898; range 0-45). The rate of cervical lymph node metastasis on pathology (pN+) was 27.8 %. Uni- and multivariate regression analysis detected no association between NY and OS or DFS (P ≥ 0.05). Advantages in OS and DFS were seen among patients without cervical lymph node metastasis (pN0) in comparison to those with pN+ necks (OS: hazard ratio [HR] 0.179; 95 % confidence interval [CI] 0.046-0.693; P = 0.013, and DFS: HR 0.190; 95 % CI 0.061-0.590; P = 0.004). ND resulted in pathologic upstaging of the neck in seven patients and downgrading in eight; increasing NY was not associated with an increased probability of a change in nodal stage. No significant association was found between NY and OS or DFS in patients undergoing TL with ND as primary therapy for advanced laryngeal SCC.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Medical Center Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. arne.boettcher@charite.de.
authors.forename: Arne
authors.initials: A
authors.lastname: Böttcher
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Medical Center Berlin, Campus Charité Mitte, Berlin, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Dommerich
authors.affiliation: Clinical Cancer Registry, Charité Comprehensive Cancer Center (CCCC), Charité - University Medical Center Berlin, Campus Charité Mitte, Berlin, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Sander
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Medical Center Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.|Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Medical Center Berlin, Campus Charité Mitte, Berlin, Germany.
authors.forename: Heidi
authors.initials: H
authors.lastname: Olze
authors.affiliation: Department of Radiooncology, Charité - University Medical Center Berlin, Campus Virchow-Klinikum, Berlin, Germany.
authors.forename: Carmen
authors.initials: C
authors.lastname: Stromberger
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Medical Center Berlin, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Annekatrin
authors.initials: A
authors.lastname: Coordes
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA.
authors.forename: Nate
authors.initials: N
authors.lastname: Jowett
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Medical Center Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Knopke
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D005858:Germany / Q000453:epidemiology; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis
keywords: HNSCC; Neck dissection; Nodal yield; Survival outcome; Total laryngectomy