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Predicting Pathologic Lymph Node Positivity in cN0 Pharynx and Larynx Cancers.

Eric M Anderson^1,2, Michael Luu³, Diana J Lu^1,2

¹Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A.

The Laryngoscope

|September 2, 2022

Summary

Elective neck dissection is recommended for pharyngeal and larynx cancer patients. Lymphovascular invasion and histologic grade are key predictors of positive lymph nodes, supporting continued use of neck dissection for cN0 patients.

Keywords:

head and neck squamous cell carcinoma hypopharynx larynx lymph nodes oropharynx

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Quantification of Tumor Cell Adhesion in Lymph Node Cryosections

Quantification of Tumor Cell Adhesion in Lymph Node Cryosections

Published on: February 9, 2020

Area of Science:

Oncology
Head and Neck Surgery
Cancer Research

Background:

Elective neck dissection is standard for pharyngeal and larynx cancer surgery, but its necessity in the modern era is debated.
Historical data largely informs current practice for these cancer types.

Purpose of the Study:

To identify predictors of lymph node metastasis in clinically node-negative (cN0) patients with pharyngeal and larynx cancers.
To evaluate the continued necessity of elective neck dissection in contemporary cancer treatment.

Main Methods:

Analysis of 4117 patients with cN0 oropharynx, larynx, and hypopharynx cancers diagnosed between 2010-2015.
Utilized the National Cancer Data Base for patient data from primary surgical cases.

Main Results:

Lymphovascular invasion (LVI) was the strongest predictor of pathologically node-positive (pN+) disease (OR 4.19).
Histologic grade also strongly predicted pN+ disease (OR 2.58).
A predictive model indicated less than 10% of cN0 patients had a <15% risk of pN+ disease.

Conclusions:

LVI and histologic grade are the most significant predictors of pN+ disease in cN0 pharyngeal and larynx cancer.
The study supports the continued recommendation for neck dissection in cN0 patients due to observed pN+ rates.