Node Count as a Quality Indicator in Surgically Treated Mucosal Head and Neck Squamous Cell Cancer

Area of Science:

• Oncology
• Surgical Pathology
• Head and Neck Surgery

Background:

• A minimum of 18 lymph nodes from neck dissection correlates with better survival and reduced recurrence in head and neck cancers.
• Factors influencing lymph node yield below this critical threshold require investigation.

Purpose of the Study:

• To identify factors associated with obtaining fewer than 18 lymph nodes during neck dissection for mucosal head and neck squamous cell carcinoma.
• To evaluate the impact of surgical extent and temporal trends on lymph node yield.

Main Methods:

• Retrospective review of 412 neck dissections in 323 patients with mucosal head and neck squamous cell carcinoma.
• Exclusion of patients with prior radiation or neck dissection.
• Multivariable regression analysis to determine factors associated with <18 lymph nodes.

Main Results:

• Specimens with <18 lymph nodes decreased from 16.2% (2015-2016) to 7.4% (2017-2018).
• Dissection of ≥3 levels (OR=0.2) and the period 2017-2018 (OR=0.4) were significantly associated with higher lymph node yields.
• No association found between node yield and stage, site, race, sex, HPV status, positive nodes, or surgeon/pathologist volume.

Conclusions:

• Increased awareness of node count as a quality indicator and the extent of dissection positively impact nodal yield.
• Lymph node count serves as a valuable quality metric for neck dissections in mucosal squamous cell carcinoma.