Skip to main content
SpringerLink
Log in

A novel classification scheme for advanced laryngeal cancer midline involvement: implications for the contralateral neck

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

There are insufficient data concerning risk factors for contralateral regional metastases in laryngeal cancer. The aim of this study was to investigate the frequency and risk factors for contralateral lymph node metastases and their dependence on midline involvement of the primary tumor in patients with advanced laryngeal squamous cell carcinoma.

Methods

58 consecutive patients (8 females, 50 males; mean age 64.2 ± 9.8 years; AJCC stage III disease in 43.1%, IVA disease in 54.4%) undergoing primary total laryngectomy with bilateral neck dissection between 2002 and 2016 have been retrospectively investigated at one of the largest university medical centers in Europe. Preoperative staging computed tomography (CT) scans were analyzed for midline involvement of the primary laryngeal cancer. As a result, a classification scheme has been established (type A: clear, type B: involved, type C: exceeded, and type D: bilateral/origin side indeterminable).

Results

Contralateral lymph node metastases (pN2c necks) were found in six cases (10.3%), from which four were diagnosed with type D (23.5% of type D cases), and one each with type B and type C midline involvement. In cases with no midline involvement (type A), a risk ratio reduction of 100% was seen. CT-based midline typing resulted in fourfold increased sensitivity for predicting contralateral metastases compared to conventional staging. Positive nodal status (pN+) significantly reduced overall and disease-free survival (HR 2.706, p < 0.05).

Conclusions

As a consequence, for type A category, a contralateral neck dissection might be avoidable accompanied by a reduction in surgical complications and operating time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Balm AJ, Lohuis PJ, Copper MP (2005) Surgical technique–unwrapping the neck node levels around a sternocleidomastoid muscle bar: a systematic way of performing (modified) radical neck dissection. Eur J Surg Oncol 31(10):1216–1221 (Epub 2005 Sep 19)

    Article  CAS  PubMed  Google Scholar 

  • Böttcher A, Dommerich S, Sander S, Olze H, Stromberger C, Coordes A, Jowett N, Knopke S (2016) Nodal yield of neck dissections and influence on outcome in laryngectomized patients. Eur Arch Otorhinolaryngol 273(10):3321–3329. doi:10.1007/s00405-016-3928-2

    Article  PubMed  Google Scholar 

  • Byers RM (1985) Modified neck dissection. A study of 967 cases from 1970 to 1980. Am J Surg 150(4):414–421

    Article  CAS  PubMed  Google Scholar 

  • Coskun HH, Medina JE, Robbins KT et al (2015) Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma. Head Neck 37(6):915–926. doi:10.1002/hed.23689 (Epub 2014 Jun 30)

    Article  PubMed  Google Scholar 

  • de Bondt RB, Nelemans PJ, Bakers F et al (2009) Morphological MRI criteria improve the detection of lymph node metastases in head and neck squamous cell carcinoma: multivariate logistic regression analysis of MRI features of cervical lymph nodes. Eur Radiol 19(3):626–633. doi:10.1007/s00330-008-1187-3 (Epub 2008 Oct 7)

    Article  PubMed  Google Scholar 

  • Gourin CG, Starmer HM, Herbert RJ et al (2015) Quality of care and short- and long-term outcomes of laryngeal cancer care in the elderly. Laryngoscope 125(10):2323–2329. doi:10.1002/lary.25378

    Article  PubMed  Google Scholar 

  • Hamoir M, Schmitz S, Gregoire V (2014) The role of neck dissection in squamous cell carcinoma of the head and neck. Curr Treat Options Oncol 15(4):611–624. doi:10.1007/s11864-014-0311-7 (Review)

    Article  PubMed  Google Scholar 

  • Joo YH, Yoo IR, Cho KJ, Park JO, Nam IC, Kim CS, Kim SY, Kim MS (2014) The value of preoperative 18F-FDG PET/CT for the assessing contralateral neck in head and neck cancer patients with unilateral node metastasis (N1-3). Clin Otolaryngol 39(6):338–344. doi:10.1111/coa.12295

    Article  PubMed  Google Scholar 

  • Kowalski LP, Franco EL, de Andrade Sobrinho J (1995) Factors influencing regional lymph node metastasis from laryngeal carcinoma. Ann Otol Rhinol Laryngol 104(6):442–447

    Article  CAS  PubMed  Google Scholar 

  • Lanzer M, Gander T, Kruse A, Luebbers HT, Reinisch S (2014) Influence of histopathologic factors on pattern of metastasis in squamous cell carcinoma of the head and neck. Laryngoscope 124(5):E160–E166. doi:10.1002/lary.24458 (Epub 2013 Nov 19)

    Article  PubMed  Google Scholar 

  • Lindberg R (1972) Distribution of cervical lymph node metastases from squamous cell carcinoma of the upper respiratory and digestive tracts. Cancer 29:1446–1449

    Article  CAS  PubMed  Google Scholar 

  • Mann W (1979) The lymphatic system of the larynx. A lymphangioscopic and ultrastructural study (author’s transl). Arch Otorhinolaryngol 225(3):165–180

    Article  CAS  PubMed  Google Scholar 

  • Marks JE, Devineni VR, Harvey J, Sessions DG (1992) The risk of contralateral lymphatic metastases for cancers of the larynx and pharynx. Am J Otolaryngol 13(1):34–39

    Article  CAS  PubMed  Google Scholar 

  • Möckelmann N, Busch CJ, Münscher A, Knecht R, Lörincz BB (2015) Timing of neck dissection in patients undergoing transoral robotic surgery for head and neck cancer. Eur J Surg Oncol 41(6):773–778. doi:10.1016/j.ejso.2015.02.002 (Epub 2015 Feb 17)

    Article  PubMed  Google Scholar 

  • National Comprehensive Cancer Network (2014) NCCN clinical practice guidelines in oncology (NCCN Guidelines)—Head and Neck Cancers, Version 2.2014

  • Ozturkcan S, Katilmis H, Ozdemir I, Tuna B, Guvenc IA, Dundar R (2009) Occult contralateral nodal metastases in supraglottic laryngeal cancer crossing the midline. Eur Arch Otorhinolaryngol 266(1):117–120. doi:10.1007/s00405-008-0721-x (Epub 2008 Jun 10)

    Article  PubMed  Google Scholar 

  • Peters TT, Castelijns JA, Ljumanovic R, Witte BI, Leemans CR, de Bree R (2012) Diagnostic value of CT and MRI in the detection of paratracheal lymph node metastasis. Oral Oncol 48(5):450–455. doi:10.1016/j.oraloncology.2011.12.003 (Epub 2012 Jan 4)

    Article  PubMed  Google Scholar 

  • Plaat RE, de Bree R, Kuik DJ et al (2005) Prognostic importance of paratracheal lymph node metastases. Laryngoscope 115(5):894–898

    Article  PubMed  Google Scholar 

  • Shah JP (1990) Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg 160(4):405–409

    Article  CAS  PubMed  Google Scholar 

  • Shah JP, Karnell LH, Hoffman HT et al (1997) Patterns of care for cancer of the larynx in the United States. Arch Otolaryngol Head Neck Surg 123(5):475–483

    Article  CAS  PubMed  Google Scholar 

  • Silver CE, Rinaldo A, Ferlito A (2007) Crile’s neck dissection. Laryngoscope 117:1974–1977

    Article  PubMed  Google Scholar 

  • Spector GJ, Sessions DG, Lenox J, Newland D, Simpson J, Haughey BH (2004) Management of stage IV glottic carcinoma: therapeutic outcomes. Laryngoscope 114:1438–1446

    Article  PubMed  Google Scholar 

  • Weber PC, Johnson JT, Myers EN (1994) The impact of bilateral neck dissection on pattern of recurrence and survival in supraglottic carcinoma. Arch Otolaryngol Head Neck Surg 120(7):703–706

    Article  CAS  PubMed  Google Scholar 

  • Werner JA, Dunne AA, Myers JN (2003) Functional anatomy of the lymphatic drainage system of the upper aerodigestive tract and its role in metastasis of squamous cell carcinoma. Head Neck 25(4):322–332

    Article  PubMed  Google Scholar 

  • Yang CY, Andersen PE, Everts EC, Cohen JI (1998) Nodal disease in purely glottic carcinoma: is elective neck treatment worthwhile? Laryngoscope 108:1006–1008

    Article  CAS  PubMed  Google Scholar 

  • Yilmaz T, Suslu N, Atay G, Gunaydin RO, Bajin MD, Ozer S (2015) The effect of midline crossing of lateral supraglottic cancer on contralateral cervical lymph node metastasis. Acta Otolaryngol 135(5):484–488. doi:10.3109/00016489.2014.986759 (Epub 2015 Feb 12)

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Arne Böttcher, Adrian Münscher & Johannes Bier

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Heidi Olze & Steffen Knopke

  3. Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Nadine Thieme

  4. Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Carmen Stromberger

  5. Clinical Cancer Registry, Charité Comprehensive Cancer Center, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany

    Steffen Sander

Authors
  1. Arne Böttcher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heidi Olze
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nadine Thieme
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carmen Stromberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steffen Sander
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Adrian Münscher
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Johannes Bier
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Steffen Knopke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arne Böttcher.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This work has not received any funding.

Ethical approval

This article does not contain any experimental study with human participants performed by any of the authors. For this type of work formal consent is not required due to its retrospective nature. Written informed consent was obtained from all individuals before surgical intervention. No identifying information is included in this article. Institutional review board approval (Appl. No.: EA2/021/15) was given.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Böttcher, A., Olze, H., Thieme, N. et al. A novel classification scheme for advanced laryngeal cancer midline involvement: implications for the contralateral neck. J Cancer Res Clin Oncol 143, 1605–1612 (2017). https://doi.org/10.1007/s00432-017-2419-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-017-2419-1

Keywords

Search

Navigation