Addressing the Neck: An NCDB Study of Clinically Node-Negative Supraglottic Squamous Cell Carcinoma

Area of Science:

• Head and Neck Surgery
• Surgical Oncology
• Otolaryngology

Background:

• Supraglottic squamous cell carcinoma (SCCa) management requires careful consideration of nodal status.
• Elective neck dissection (END) is a key component in the surgical management of SCCa.
• Accurate assessment of occult nodal metastasis is crucial for treatment planning.

Purpose of the Study:

• To determine the rate of END in surgically managed supraglottic SCCa.
• To identify factors associated with END.
• To evaluate the impact of neck management on overall survival (OS).

Main Methods:

• Retrospective analysis of the National Cancer Database (NCDB) 2019.
• Inclusion of patients with previously untreated, clinically node-negative (cN0) supraglottic SCCa treated with partial laryngectomy.
• Logistic regression and Cox proportional hazard analyses were used to assess associations.

Main Results:

• 60% of 1352 eligible patients underwent END, with 22% showing occult nodal metastasis.
• END was more frequent at academic centers (OR: 1.66, 95% CI: 1.32-2.09).
• Adjuvant radiation was associated with worse OS (HR: 1.45, 95% CI: 1.13-3.29), while END showed a trend towards improved OS on univariable analysis.

Conclusions:

• A significant proportion (22%) of cN0 supraglottic SCCa patients have occult nodal disease.
• 40% of patients did not receive END, indicating a potential gap in care.
• END in supraglottic SCCa patients may allow avoidance of adjuvant radiation without compromising OS.