Elective neck dissection versus observation in patients with head and neck cutaneous squamous cell carcinoma.
head and neck
lymph node
metastasis
neck dissection
skin
squamous cell carcinoma
survival
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
01 12 2021
01 12 2021
Historique:
revised:
18
04
2021
received:
28
01
2021
accepted:
26
04
2021
pubmed:
7
8
2021
medline:
11
3
2022
entrez:
6
8
2021
Statut:
ppublish
Résumé
The survival benefit of elective neck dissection (END) for patients with cutaneous squamous cell carcinoma (cSCC) of the head and neck and no evidence of regional metastasis (cN0) has never been reported. The aim of this study was to determine the effect of END on patient survival. The authors included patients with head and neck cSCC who had undergone primary surgery from 1995 to 2017. The primary end point was survival, and the secondary end points were the incidence of occult regional disease and regional disease control. To assess the impact of END on survival, the authors used multivariable Cox proportional hazards models with propensity score and matching techniques for internal validation. A total of 1111 patients presented with no evidence of nodal disease; 173 had END, and 938 were observed. Adjuvant radiotherapy to the neck was administered to 101 patients (9%). END resulted in a 5-year overall survival rate of 52%, whereas the rate was 63% in the observation group (P = .003 [log-rank]). The 5-year disease-free survival rate for patients undergoing END was similar to that for the observation group (73% vs 75%; P = .429). A multivariate regression model showed that the performance of END was not associated with improved rates of overall, disease-specific, or disease-free survival; similarly, among patients with advanced disease (T3-4), those who underwent END did not have improved survival rates. Among patients with cSCC of the head and neck, observation of the neck nodes resulted in noninferior survival rates in comparison with END at the time of primary surgery. Further studies are required to elucidate the role of END in patients with advanced disease.
Sections du résumé
BACKGROUND
The survival benefit of elective neck dissection (END) for patients with cutaneous squamous cell carcinoma (cSCC) of the head and neck and no evidence of regional metastasis (cN0) has never been reported. The aim of this study was to determine the effect of END on patient survival.
METHODS
The authors included patients with head and neck cSCC who had undergone primary surgery from 1995 to 2017. The primary end point was survival, and the secondary end points were the incidence of occult regional disease and regional disease control. To assess the impact of END on survival, the authors used multivariable Cox proportional hazards models with propensity score and matching techniques for internal validation.
RESULTS
A total of 1111 patients presented with no evidence of nodal disease; 173 had END, and 938 were observed. Adjuvant radiotherapy to the neck was administered to 101 patients (9%). END resulted in a 5-year overall survival rate of 52%, whereas the rate was 63% in the observation group (P = .003 [log-rank]). The 5-year disease-free survival rate for patients undergoing END was similar to that for the observation group (73% vs 75%; P = .429). A multivariate regression model showed that the performance of END was not associated with improved rates of overall, disease-specific, or disease-free survival; similarly, among patients with advanced disease (T3-4), those who underwent END did not have improved survival rates.
CONCLUSIONS
Among patients with cSCC of the head and neck, observation of the neck nodes resulted in noninferior survival rates in comparison with END at the time of primary surgery. Further studies are required to elucidate the role of END in patients with advanced disease.
Identifiants
pubmed: 34358340
doi: 10.1002/cncr.33773
pmc: PMC10187975
mid: NIHMS1826637
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
4413-4420Subventions
Organisme : NCI NIH HHS
ID : R01 CA187076
Pays : United States
Organisme : NCI NIH HHS
ID : F30 CA228258
Pays : United States
Organisme : NCI NIH HHS
ID : R37 CA242006
Pays : United States
Informations de copyright
© 2021 American Cancer Society.
Références
Laryngoscope. 2003 Oct;113(10):1827-33
pubmed: 14520114
JAMA Dermatol. 2014 Jan;150(1):19-24
pubmed: 24226651
Am J Otolaryngol. 2000 Jan-Feb;21(1):31-7
pubmed: 10668674
Lancet Oncol. 2008 Aug;9(8):713-20
pubmed: 18617440
Cancer. 2009 May 1;115(9):1883-91
pubmed: 19224549
Am J Otolaryngol. 2017 May - Jun;38(3):325-328
pubmed: 28202188
Head Neck. 2016 Apr;38 Suppl 1:E884-9
pubmed: 25965008
J Am Acad Dermatol. 2013 Jun;68(6):957-66
pubmed: 23375456
Laryngoscope. 2005 Sep;115(9):1561-7
pubmed: 16148695
Am Soc Clin Oncol Educ Book. 2018 May 23;38:505-514
pubmed: 30231400
Medicine (Baltimore). 2018 Jun;97(22):e10782
pubmed: 29851784
Facial Plast Surg Clin North Am. 2012 Nov;20(4):473-81
pubmed: 23084299
Laryngoscope. 2005 May;115(5):870-5
pubmed: 15867656
Cancer. 2006 Jun 1;106(11):2389-96
pubmed: 16649220
Arch Otolaryngol Head Neck Surg. 2008 May;134(5):536-8
pubmed: 18490577
Dermatol Surg. 2000 Mar;26(3):289-92
pubmed: 10759812
Cancer Chemother Rep. 1966 Mar;50(3):163-70
pubmed: 5910392
Laryngoscope. 2021 Jan;131(1):E136-E143
pubmed: 32065413