Lymph Node Count From Neck Dissection Predicts Mortality in Head and Neck Cancer

Area of Science:

• Oncology
• Surgical Pathology

Background:

• Smaller studies suggest a link between lymph node (LN) count and survival in head and neck cancer.
• A comprehensive analysis using a national database is needed to confirm this association.

Purpose of the Study:

• To investigate the association between lymph node count from neck dissection and overall survival in a large cohort of head and neck cancer patients.
• To determine if lymph node count can serve as a quality metric for neck dissection.

Main Methods:

• Utilized the National Cancer Database (2004-2013) to identify patients with mucosal head and neck squamous cell carcinoma undergoing upfront nodal dissection.
• Stratified patients into groups with <18 and ≥18 lymph nodes examined.
• Employed multivariable Cox proportional hazards regression to analyze mortality risk, with stratification by nodal status (negative vs. positive).

Main Results:

• Analyzed 64,000+ patients (18,865 with <18 LNs, 45,113 with ≥18 LNs).
• The <18 LN group exhibited more favorable tumor characteristics.
• Risk-adjusted models revealed an 18% increased hazard of death for patients with <18 LNs (HR 1.18).
• Increased mortality hazard was observed in both node-negative (HR 1.24) and node-positive (HR 1.12) patients with <18 LNs.

Conclusions:

• Examining ≥18 lymph nodes in neck dissection is significantly associated with improved overall survival for head and neck cancer patients.
• This association is consistent across both clinically node-negative and node-positive patient groups.
• Lymph node count emerges as a potential quality indicator for the thoroughness of neck dissection.