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Prognostic Significance of Lymph Node Ratio in Metastatic Cutaneous Squamous Cell Carcinoma of the Head and Neck

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The prognostic variables in patients with metastatic cutaneous nodal squamous cell carcinoma (SCC) are well documented; however, the relationship between lymph node ratio (LNR) and outcome is not well researched. LNR represents the ratio of positive lymph nodes to total excised lymph nodes. We analyzed the correlation between LNR and outcome in patients who have undergone surgery for metastatic cutaneous nodal SCC of the head and neck.

Methods

Analysis was performed on retrospectively collected data, identifying patients who underwent surgery at Westmead Hospital, Sydney. Pathology reports were reviewed to ascertain LNR. A log-rank test identified a specific LNR value to compare time to disease progression (TTDP) and overall survival (OS). Multivariate proportional hazard regression models were used to review outcome.

Results

In total, 193 males and 45 females with a median of age 68 years were identified, with a mean recorded LNR of 0.15. On multivariate analysis, an LNR cutpoint of 0.21 was a significant predictor of decreased TTDP [hazard ratio (HR) 2.34, 95 % confidence interval (CI) 4.40–0.49; p = 0.009] and OS (HR 2.75, 95 % CI 1.57–4.82; p < 0.001). Forty-nine of 238 patients (21 %) developed recurrence, with most recurrences being regional (29 of 49; 59 %). A total of 17 % of patients with an LNR ≤0.21 recurred compared with 40 % for patients with an LNR >0.21.

Conclusions

LNR is potentially an independent predictor of outcome in patients with metastatic cutaneous nodal SCC. The clinical relevance of this finding requires further validation.

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References

  1. Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012;166:1069–80.

    Article  CAS  PubMed  Google Scholar 

  2. Fransen M, Karahalios A, Sharma N, English DR, Giles GG, Sinclair RD. Non-melanoma skin cancer in Australia. Med J Aust. 2012;197:565–8.

    Article  PubMed  Google Scholar 

  3. Veness MJ, Palme CE, Morgan GJ. High-risk cutaneous squamous cell carcinoma of the head and neck: results from 266 patients treated with metastatic nodal disease. Cancer. 2006;106:2389–96.

    Article  PubMed  Google Scholar 

  4. Veness MJ, Morgan GJ, Palme CE, Gebski V. Surgery and adjuvant radiotherapy in patients with cutaneous head and neck squamous cell carcinoma metastatic to lymph nodes: combined treatment should be considered best practice. Laryngoscope. 2005;115:870–5.

    Article  PubMed  Google Scholar 

  5. Karia PS, Han J, Schmults CD. Cutaneous squamous cell carcinoma: estimated incidence of disease, nodal metastasis, and deaths from disease in the United States, 2012. J Am Acad Dermatol. 2013;68:957–66.

    Article  PubMed  Google Scholar 

  6. Oddone N, Morgan G, Palme C, et al. Metastatic cutaneous squamous cell carcinoma of the head and neck: the immunosuppression, treatment, extranodal spread, and margin status (ITEM) prognostic score to predict outcome and the need to improve survival. Cancer. 2009;115:1883–91.

    Article  PubMed  Google Scholar 

  7. Xu DZ, Geng QR, Long ZJ, et al. Positive lymph node ratio is an independent prognostic factor in gastric cancer after d2 resection regardless of the examined number of lymph nodes. Ann Surg Oncol. 2009;16:319–26.

    Article  PubMed  Google Scholar 

  8. Duraker N, Bati B, Caynak ZC, Demir D. Lymph node ratio may be supplementary to TNM nodal classification in node-positive breast carcinoma based on the results of 2151 patients. World J Surg. 2013;37:1241–8.

    Article  PubMed  Google Scholar 

  9. Prabhu RS, Hanasoge S, Magliocca KR, et al. Lymph node ratio influence on risk of head and neck cancer locoregional recurrence after initial surgical resection: implications for adjuvant therapy. Head Neck. 2015;37:777–82.

    Article  PubMed  Google Scholar 

  10. Kunzel J, Psychogios G, Mantsopoulos K, Grundtner P, Waldfahrer F, Iro H. Lymph node ratio as a predictor of outcome in patients with oropharyngeal cancer. Eur Arch Otorhinolaryngol. 2014;271:1171–80.

    Article  PubMed  Google Scholar 

  11. Amit M, Yen TC, Liao CT, et al. Improvement in survival of patients with oral cavity squamous cell carcinoma: an international collaborative study. Cancer. 2013;119:4242–8.

    Article  PubMed  Google Scholar 

  12. Mizrachi A, Hadar T, Rabinovics N, et al. Prognostic significance of nodal ratio in cutaneous squamous cell carcinoma of the head and neck. Eur Arch Otorhinolaryngol. 2013;270:647–53.

    Article  PubMed  Google Scholar 

  13. Altman DG, Lausen B, Sauerbrei W, Schumacher M. Dangers of using “optimal” cutpoints in the evaluation of prognostic factors. J Natl Cancer Inst. 1994;86:829–35.

    Article  CAS  PubMed  Google Scholar 

  14. Wang JT, Palme CE, Morgan GJ, Gebski V, Wang AY, Veness MJ. Predictors of outcome in patients with metastatic cutaneous head and neck squamous cell carcinoma involving cervical lymph nodes: improved survival with the addition of adjuvant radiotherapy. Head Neck. 2012;34:1524–8.

    Article  PubMed  Google Scholar 

  15. Forest VI, Clark JJ, Veness MJ, Milross C. N1S3: a revised staging system for head and neck cutaneous squamous cell carcinoma with lymph node metastases: results of two Australian cancer centres. Cancer. 2010;116:1298–1304.

    Article  PubMed  Google Scholar 

  16. Andruchow JL, Veness MJ, Morgan GJ, et al. Implications for clinical staging of metastatic cutaneous SCC of the head and neck based on a multicentre study of treatment outcomes. Cancer. 2006;106:1078–83.

    Article  PubMed  Google Scholar 

  17. Aurello P, Catracchia V, Petrucciani N, et al. What is the role of nodal ratio as a prognostic factor for gastric cancer nowadays? Comparison with new TNM staging system and analysis according to the number of resected nodes. Am Surg. 2013;79:483–91.

    PubMed  Google Scholar 

  18. Clark JR, Rumcheva P, Veness MJ. Analysis and comparison of the 7th edition American Joint Committee on Cancer (AJCC) nodal staging system for metastatic cutaneous squamous cell carcinoma of the head and neck. Ann Surg Oncol. 2012;19:4252–8.

    Article  PubMed  Google Scholar 

  19. Brunner M, Ng BC, Veness MJ, Clark JR. Comparison of the AJCC N staging system in mucosal and cutaneous squamous head and neck cancer. Laryngoscope. 2014;124:1598–602.

    Article  PubMed  Google Scholar 

  20. Ebrahimi A, Clark JR, Amit M, et al. Minimum nodal yield in oral squamous cell carcinoma: defining the standard of care in a multicenter international pooled validation study. Ann Surg Oncol. 2014;21:3049–55.

    Article  PubMed  Google Scholar 

  21. Wang J, Palme C, Wang A, Morgan G, Gebski V, Veness M. In patients with metastatic cutaneous SCC to cervical lymph nodes, the extent of neck dissection does not influence outcome. J Laryngol Otol. 2013;127 Supp 1:S2–7.

    Article  PubMed  Google Scholar 

  22. Bernier J, Cooper JS, Pajak TF, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (#9501). Head Neck. 2005;27:843–50.

    Article  PubMed  Google Scholar 

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Disclosure

Evan A. Tseros, Val Gebski, Gary J. Morgan, and Michael J. Veness deny any conflicts of interest or financial support for this study.

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Authors and Affiliations

  1. Crown Princess Mary Cancer Centre, Westmead Hospital, University of Sydney, Sydney, NSW, Australia

    Evan A. Tseros MBBS, BMSc, MSurg & Val Gebski BA, MStat, FRANZCR (Hon)

  2. NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia

    Val Gebski BA, MStat, FRANZCR (Hon)

  3. Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, University of Sydney, Sydney, NSW, Australia

    Gary J. Morgan MBBS, BDS, FRACDS, FRACS, FACS & Michael J. Veness MBBS, MD (UNSW), MD (USyd), MMed, FRANZCR

  4. Department of Radiation Oncology, Westmead Hospital, Sydney, NSW, Australia

    Michael J. Veness MBBS, MD (UNSW), MD (USyd), MMed, FRANZCR

Authors
  1. Evan A. Tseros MBBS, BMSc, MSurg
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  2. Val Gebski BA, MStat, FRANZCR (Hon)
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  3. Gary J. Morgan MBBS, BDS, FRACDS, FRACS, FACS
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  4. Michael J. Veness MBBS, MD (UNSW), MD (USyd), MMed, FRANZCR
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Corresponding author

Correspondence to Michael J. Veness MBBS, MD (UNSW), MD (USyd), MMed, FRANZCR.

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Tseros, E.A., Gebski, V., Morgan, G.J. et al. Prognostic Significance of Lymph Node Ratio in Metastatic Cutaneous Squamous Cell Carcinoma of the Head and Neck. Ann Surg Oncol 23, 1693–1698 (2016). https://doi.org/10.1245/s10434-015-5070-6

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  • DOI: https://doi.org/10.1245/s10434-015-5070-6

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