Annals of Surgical Oncology

, Volume 20, Issue 11, pp 3575–3581

Clinical Nodal Stage is a Significant Predictor of Outcome in Patients with Oral Cavity Squamous Cell Carcinoma and Pathologically Negative Neck Metastases: Results of the International Consortium for Outcome Research

  • M. Amit
  • T. C. Yen
  • C. T. Liao
  • Y. Binenbaum
  • P. Chaturvedi
  • J. P. Agarwal
  • L. P. Kowalski
  • A. Ebrahimi
  • J. R. Clark
  • C. R. Cernea
  • S. J. Brandao
  • M. Kreppel
  • J. Zöller
  • D. Fliss
  • G. Bachar
  • T. Shpitzer
  • V. A. Bolzoni
  • P. R. Patel
  • S. Jonnalagadda
  • K. T. Robbins
  • J. P. Shah
  • S. G. Patel
  • Ziv Gil
  • The International Consortium for Outcome Research (ICOR) in Head and Neck Cancer
Head and Neck Oncology

DOI: 10.1245/s10434-013-3044-0

Cite this article as:
Amit, M., Yen, T.C., Liao, C.T. et al. Ann Surg Oncol (2013) 20: 3575. doi:10.1245/s10434-013-3044-0
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Abstract

Background

We aimed to study the importance of clinical N classification (cN) in a subgroup of patients with oral cavity squamous cell carcinoma (OSCC) and pathologically negative neck nodes (pN−).

Methods

A total of 2,258 patients from 11 cancer centers who underwent neck dissection for OSCC (1990–2011) had pN− disease. The median follow-up was 44 months. 5-year overall survival (OS), disease-specific survival (DSS), disease free survival, local control, locoregional control, and distant metastasis rates were calculated by the Kaplan–Meier method. cN classification and tumor, node, metastasis classification system staging variables were subjected to multivariate analysis.

Results

A total of 345 patients were preoperatively classified as cN+ and 1,913 were classified as cN−. The 5-year OS and DSS of cN− patients were 73.6 and 82.2 %, respectively. The 5-year OS and DSS of cN+ patients were 64.9 and 76.9 %, respectively (p < 0.0001 each). A cN+ classification was a significant predictor of worse OS (p = 0.03) and DSS (p = 0.016), regardless of treatment, depth of invasion, or extent of neck dissection. cN classification was associated with recurrence-free survival (p = 0.01) and locoregional (neck and primary tumor) control (p = 0.004), but not with local (p = 0.19) and distant (p = 0.06) recurrence rates.

Conclusions

Clinical evidence of neck metastases is an independent predictor of outcome, even in patients with pN− nodes.

Supplementary material

10434_2013_3044_MOESM1_ESM.bmp (675 kb)
Supplemental figure 1. The impact of adjuvant chemotherapy on outcome in cN+/pN- patients. (A) Five-year overall survival and (B) disease-specific survival calculated using the Kaplan-Meier analysis in patients with clinically positive neck nodes and pathologically negative neck nodes. CRT adjuvant chemoradiation therapy (red line), RT adjuvant radiotherapy (blue line). (BMP 675 kb)

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • M. Amit
    • 1
    • 2
  • T. C. Yen
    • 3
  • C. T. Liao
    • 3
  • Y. Binenbaum
    • 1
  • P. Chaturvedi
    • 4
  • J. P. Agarwal
    • 4
  • L. P. Kowalski
    • 5
  • A. Ebrahimi
    • 6
  • J. R. Clark
    • 6
  • C. R. Cernea
    • 7
  • S. J. Brandao
    • 7
  • M. Kreppel
    • 8
  • J. Zöller
    • 8
  • D. Fliss
    • 9
  • G. Bachar
    • 10
  • T. Shpitzer
    • 10
  • V. A. Bolzoni
    • 11
  • P. R. Patel
    • 12
  • S. Jonnalagadda
    • 13
  • K. T. Robbins
    • 14
  • J. P. Shah
    • 14
  • S. G. Patel
    • 14
  • Ziv Gil
    • 1
    • 2
  • The International Consortium for Outcome Research (ICOR) in Head and Neck Cancer
  1. 1.The Laboratory for Applied Cancer ResearchRambam Medical CenterHaifaIsrael
  2. 2.Department of Otolaryngology Head and Neck Surgery, Rambam Medical Center, Rappaport School of Medicine, The TechnionIsrael Institute of TechnologyHaifaIsrael
  3. 3.Chang Gung Memorial HospitalTaoyuanTaiwan
  4. 4.Tata Memorial HospitalMumbaiIndia
  5. 5.Hospital A. C. CamargoSão PauloBrazil
  6. 6.Sydney Head and Neck Cancer InstituteRoyal Prince Alfred HospitalSydneyAustralia
  7. 7.Department of Head and Neck SurgeryUniversity of São Paulo Medical SchoolSão PauloBrazil
  8. 8.Department of Oral and Cranio-Maxillo and Facial Plastic SurgeryUniversity of CologneCologneGermany
  9. 9.Department of Otolaryngology Head and Neck SurgeryTel Aviv Medical CenterTel AvivIsrael
  10. 10.Department of Otolaryngology Head and Neck SurgeryRabin Medical CenterPetach TikvaIsrael
  11. 11.Department of ENTUniversity of BresciaBresciaItaly
  12. 12.University of AucklandAucklandNew Zealand
  13. 13.Southern Illinois University School of MedicineChicagoUSA
  14. 14.Head and Neck Surgery ServiceMemorial Sloan-Kettering Cancer CenterNew YorkUSA