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Refining the Role of Lymph Node Biopsy in Survival for Patients with Nasopharyngeal Carcinoma: Population-Based Study from the Surveillance Epidemiology and End-Results Registry

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

Abstract

Background

The updated version of the National Comprehensive Cancer Network (NCCN) guidelines revised pretreatment workup for nasopharyngeal carcinoma (NPC) into “biopsy of the primary site or neck.” Despite provision of important diagnostic information, concerns regarding tumor cell dissemination limit the application of lymph node biopsy. This study aimed to investigate whether biopsy of the neck is associated with impaired survival in NPC.

Methods

A propensity score-matched, population-based cohort identified from the Surveillance, Epidemiology, and End Results database was used to compare overall survival (OS) and disease-specific survival (DSS) of patients who underwent pretreatment cervical lymph node biopsy without subsequent neck dissection or removal of node compared with patients who did not undergo node biopsy.

Results

Of 2910 eligible patients, 416 (14.3%) underwent pretreatment lymph node biopsy. After use of control for patient, tumor, and demographic characteristics, biopsy was not associated with impaired OS (hazard ratio [HR], 1.15; 95% confidence interval [CI] 0.89–1.47; P = 0.29) or DSS (HR, 1.07; 95% CI 0.81–1.40; P = 0.63). Interestingly, in the subgroup analysis, the unfavorable effect of biopsy was observed for patients with differentiated non-keratinizing squamous cell carcinoma (but not other histologic types). Race did not positively alter the survival outcomes.

Conclusions

The findings provide reference for clinical practice, showing that pretreatment cervical lymph node biopsy is not associated with impaired survival in NPC, except for patients with differentiated non-keratinizing squamous cell carcinoma. The recommended NCCN guidelines would be more specific by adding details to the general recommendation that neck biopsy is safe for all patients. Future prospective studies are needed to verify the study findings.

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References

  1. US National Institutes of Health. Glossary of Clinical Trial Terms. http://www.clinicaltrials.gov/ct2/info/glossary.

  2. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA. 2011;61:69–90.

  3. Wei KR, Zheng RS, Zhang SW, Liang ZH, Ou ZX, Chen WQ. Nasopharyngeal carcinoma incidence and mortality in China in 2010. Chin J Cancer. 2014;33:381–7.

    PubMed  PubMed Central  Google Scholar 

  4. Wang X, Hu C, Ying H, et al. Patterns of lymph node metastasis from nasopharyngeal carcinoma based on the 2013 updated consensus guidelines for neck node levels. Radiother Oncol. 2015;115:41–5.

    Article  PubMed  Google Scholar 

  5. Grau C, Johansen LV, Jakobsen J, Geertsen P, Andersen E, Jensen BB. Cervical lymph node metastases from unknown primary tumours: results from a national survey by the Danish Society for Head and Neck Oncology. Radiother Oncol. 2000;55:121–9.

    Article  CAS  PubMed  Google Scholar 

  6. Tong CC, Luk MY, Chow SM, Ngan KC, Lau WH. Cervical nodal metastases from occult primary: undifferentiated carcinoma versus squamous cell carcinoma. Head Neck. 2002;24:361–9.

    Article  PubMed  Google Scholar 

  7. Pfister DG, Spencer S, Brizel DM, et al. Head and neck cancers, version 2.2014. Clinical practice guidelines in oncology. JNCCN J Natl Compr Cancer Netw. 2014;12:1454–87.

    Article  Google Scholar 

  8. Pfister DG, Spencer S, Brizel DM, et al. Head and neck cancers, version 1.2015. JNCCN J Natl Compr Cancer Netw. 2015;13:847–55; quiz 856.

  9. NCCN Clinical Practice Guidelines in Oncology Head and Neck Cancers, version 1.2016. NCCN.org. Oct 2016.

  10. Chan AT, Gregoire V, Lefebvre JL, et al. Nasopharyngeal cancer: EHNS-ESMO-ESTRO clinical practice guidelines for diagnosis, treatment, and follow-up. Ann Oncol. 2012;23(Suppl 7):vii83–5.

  11. AlHilli MM, Podratz KC, Dowdy SC, et al. Preoperative biopsy and intraoperative tumor diameter predict lymph node dissemination in endometrial cancer. Gynecol Oncol. 2013;128:294–9.

    Article  PubMed  Google Scholar 

  12. Sano Y, Date H, Toyooka S, et al. Percutaneous computed tomography-guided lung biopsy and pleural dissemination: an assessment by intraoperative pleural lavage cytology. Cancer. 2009;115:5526–33.

    Article  PubMed  Google Scholar 

  13. Heimbach JK, Sanchez W, Rosen CB, Gores GJ. Transperitoneal fine-needle aspiration biopsy of hilar cholangiocarcinoma is associated with disease dissemination. HPB. 2011;13:356–60.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Paterson R, Nuttal JR. An evaluation of the risk of biopsy in squamous carcinoma: a clinical experiment. Am J Cancer. 1998;37:64–7.

    Google Scholar 

  15. Cai WM, Zhang HX, Hu YH, Gu XZ. Influence of biopsy on the prognosis of nasopharyngeal carcinoma: a critical study of biopsy from the nasopharynx and cervical lymph node of 649 patients. Int J Radiat Oncol Biol Phys. 1983;9:1439–44.

    Article  CAS  PubMed  Google Scholar 

  16. Dickson RI. Nasopharyngeal carcinoma: an evaluation of 209 patients. Laryngoscope. 1981;91:333–54.

    Article  CAS  PubMed  Google Scholar 

  17. Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002;40(8 Suppl):IV-3-18.

  18. NC. I. Summary staging guide, SEER Program. National Institutes of Health. NIH Publication 1981; No. 81(12):598–603.

  19. Gimotty PA, Yoon F, Hammond R, Rosenbaum P, Guerry D. Therapeutic effect of sentinel lymph node biopsy in melanoma remains an open question. J Clin Oncol. 2009;27:4236–8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Greene FL PD, Fleming ID, et al. AJCC cancer staging handbook from the AJCC cancer staging manual. 6th ed. New York: Springer; 2002.

    Book  Google Scholar 

  21. Austin PC. Statistical criteria for selecting the optimal number of untreated subjects matched to each treated subject when using many-to-one matching on the propensity score. Am J Epidemiol. 2010;172:1092–7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hu XJ, Lagakos SW. Nonparametric estimation of the mean function of a stochastic process with missing observations. Lifetime Data Anal. 2007;13:51–73.

    Article  PubMed  Google Scholar 

  23. O’Quigley J, Moreau T. Testing the proportional hazards regression model against some general alternatives. Revue D’epidemiologie et de Sante Publique. 1984;32:199–205.

  24. Rothbarth J, Wijnhoven BP. Lymphatic dissemination and the role of sentinel lymph node biopsy in early gastric cancer. Dig Surg. 2012;29:130–1.

    Article  CAS  PubMed  Google Scholar 

  25. Jones OM, Rees M, John TG, Bygrave S, Plant G. Biopsy of resectable colorectal liver metastases causes tumour dissemination and adversely affects survival after liver resection. Br J Surg. 2005;92:1165–8.

    Article  CAS  PubMed  Google Scholar 

  26. Ambs A, Warren JL, Bellizzi KM, Topor M, Haffer SC, Clauser SB. Overview of the SEER–Medicare Health Outcomes Survey linked dataset. Health Care Financing Rev. 2008;29:5–21.

    Google Scholar 

  27. Lin CC, Virgo KS, Robbins AS, Jemal A, Ward EM. Comparison of comorbid medical conditions in the National Cancer Database and the SEER-Medicare Database. Ann Surg Oncol. 2016;23:4139–48.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by Grants from the National Natural Science Foundation of China (No. 81372409), the Science and Technology Project of Guangzhou City, China (No. 132000507), the National Natural Science Foundation of China (No. 81402532), and the National Natural Science Foundation of China (No. 81572962). We thank the staff members at the National Cancer Institute and their colleagues across the United States and at the Information Management Services, Inc., who have been involved in the Surveillance, Epidemiology and End Results (SEER) Program.

Conflict of interest

There are no conflicts of interest.

Author information

Author notes

  1. Jia-Wei Lv, Guan-Qun Zhou, and Yu-Pei Chen have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China

    Jia-Wei Lv MD, Guan-Qun Zhou MD, Yu-Pei Chen MD, Ling-Long Tang MD, Yan-Ping Mao MD, Lei Chen MD, Wen-Fei Li MD, Jun Ma MD, PhD & Ying Sun MD, PhD

  2. Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China

    Ai-Hua Lin MD, PhD

Authors
  1. Jia-Wei Lv MD
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  2. Guan-Qun Zhou MD
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  3. Yu-Pei Chen MD
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Corresponding author

Correspondence to Ying Sun MD, PhD.

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Supplementary material 2 (DOCX 83 kb)

10434_2017_5966_MOESM3_ESM.tif

Supplementary material 3 (TIFF 570 kb). Overall (A) and nasopharyngeal carcinoma-specific survival (B) for the subgroups of patients treated with curative intent and with at least 5-years follow-up. P-values were calculated using the unadjusted log-rank test

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Lv, JW., Zhou, GQ., Chen, YP. et al. Refining the Role of Lymph Node Biopsy in Survival for Patients with Nasopharyngeal Carcinoma: Population-Based Study from the Surveillance Epidemiology and End-Results Registry. Ann Surg Oncol 24, 2580–2587 (2017). https://doi.org/10.1245/s10434-017-5966-4

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  • DOI: https://doi.org/10.1245/s10434-017-5966-4

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