Impact of Neck Dissection in Head and Neck Squamous Cell Carcinomas of Unknown Primary
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Neck Dissection Extent | All Patients N = 322 | No ND N = 53 | Adenectomy N = 33 | Selective ND N = 116 | Modified Radical/Radical ND N = 120 | p-Value | ||
---|---|---|---|---|---|---|---|---|
Patients | ||||||||
Male | 271 (84.2%) | 48 (90.6%) | 26 (78.8%) | 95 (81.9%) | 102 (85.0%) | 0.414 | ||
Female | 51 (15.8%) | 5 (9.4%) | 7 (21.2%) | 21 (18.1%) | 18 (15.0%) | |||
Age (years) | 61.5; 62.3 +/− 10.3 | 62.6; 64.4 +/− 11.4 | 65.6; 64.8 +/− 12.2 | 61.2; 61.0 +/− 9.5 | 61.4; 62.1 +/− 9.9 | 0.330 | ||
Tumors | ||||||||
Extension staging, including: | ||||||||
Head and neck CT | ||||||||
Head and neck MRI | 303 (94.1%) | 51 (96.3%) | 33 (100.0%) | 108 (93.1%) | 111 (92.5%) | 0.353 | ||
Chest-abdomn-pelvic | 45 (14%) | 6 (11.3%) | 0 | 24 (20.9%) | 15 (12.5%) | 0.015 | ||
CT | 175 (56.6%) | 32 (64.0%) | 21 (75.0%) | 62 (54.9%) | 60 (50.9%) | 0.082 | ||
18-FDG PET-CT | 265 (82.6%) | 44 (83.0%) | 29 (87.8%) | 99 (85.3%) | 93 (78.2%) | 0.409 | ||
Nodal stage: | <0.001 | |||||||
N1 + N2a | 104 (32.3%) | 10 (18.9%) | 16 (48.5%) | 43 (37.1%) | 35 (29.2%) | |||
N2b | 106 (32.9%) | 12 (22.6%) | 8 (24.2%) | 48 (41.4%) | 38 (31.7%) | |||
N2c + N3 | 112 (34.8%) | 31 (58.5%) | 9 (27.3%) | 25 (21.6%) | 47 (39.2%) | |||
Diameter of largest cervical node (cm) | 4.5; 5.7 +/− 6.1 | 6; 6.5 +/− 3.6 | 4; 8.2 +/− 11.2 | 3.5; 5.6 +/− 7.8 | 5.0; 4.8 +/− 2.0 | <0.001 | ||
Extracapsular spread a | 209 (71.8%) | 25 (75.8%) | 21 (70.0%) | 74 (64.9%) | 89 (78.1%) | 0.158 | ||
Conventional squamous cell carcinoma | 316 (98.1%) | 53 (100%) | 33 (100%) | 112 (96.6%) | 118 (98.3%) | 0.354 | ||
Variant of squamous cell carcinoma | 6 (1.9%) | 0 | 0 | 4 (3.5%) | 2 (1.7%) | |||
Histological differentiation a | 0.357 | |||||||
Well differentiated | 120 (43.8%) | 25 (51.1%) | 13 (48.1%) | 46 (46%) | 39 (37.5%) | |||
Keratinizing | 85 (31%) | 18 (41.9%) | 13 (48.1%) | 28 (28%) | 26 (24.8%) | |||
Non-keratinizing | 24 (8.8%) | 2 (4.6%) | 0 | 12 (12%) | 10 (9.5%) | |||
NOS | 11 (4%) | 5 (4.6%) | 0 | 6 (6%) | 3 (2.9%) | |||
Moderately differentiated | 71 (25.9%) | 9 (20.9%) | 7 (25.9%) | 26 (26%) | 29 (27.9%) | |||
Poorly differentiated | 76 (27.7%) | 10 (23.4%) | 7 (25.9%) | 25 (25%) | 34 (32.7%) | |||
Undifferentiated | 7 (2.6%) | 2 (4.6%) | 0 | 3 (3%) | 2 (1.9%) | |||
HPV status a | − | |||||||
Positive | 14 (26.4%) | 0 | 1 (100%) | 8 (23.5%) | 5 (31.3%) | |||
Negative | 39 (73.6%) | 2 (100%) | 0 | 26 (76.5%) | 11 (68.8%) |
Prognostic Analysis by Event | Local Relapse | Nodal Relapse | Metastatic Relapse | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Bivariate Analysis | Multivariate Analysis | Bivariate Analysis | Multivariate Analysis | Bivariate Analysis | Multivariate Analysis | |||||||
HR 95% CI | p-Value | HR 95% CI | p-Value | HR 95% CI | p-Value | HR 95% CI | p-Value | HR 95% CI | p-Value | HR 95% CI | p-Value | |
Patients | ||||||||||||
Male gender | 2.34 [0.57; 9.59] | 0.238 | 1.74 [0.62; 4.89] | 0.292 | 1.14 [0.49; 2.67] | 0.755 | ||||||
Age at diagnosis | 1.04 [0.99; 1.08] | 0.091 | 1.03 [1; 1.06] | 0.066 | 1.04 [1; 1.07] | 0.030 | ||||||
Tumors | ||||||||||||
Initial imaging 18-FDG PET-CT | 0.58 [0.25; 1.32] | 0.195 | 0.92 [0.42; 2.05] | 0.844 | 0.46 [0.24; 0.87] | 0.016 | 0.46 [0.24; 0.89] | 0.021 | ||||
Diameter of largest node (cm) | 1.00 [0.96; 1.04] | 0.910 | 1.03 [0.99; 1.06] | 0.115 | 1.05 [1.03; 1.08] | <0.001 | 1.05 [1.02; 1.08] | <0.001 | ||||
Nodal staging | ||||||||||||
N1 + N2a | 1 | 1 | 1 | 1 | 1 | 1 | ||||||
N2b | 0.79 [0.28; 2.25] | 0.659 | 0.81 [0.28; 2.30] | 0.689 | 2.13 [0.81; 5.57] | 0.124 | 1.90 [0.71; 5.11] | 0.200 | 1.13 [0.5; 2.52] | 0.772 | 0.76 [0.32; 1.80] | 0.536 |
N2c + N3 | 1.38 [0.57; 3.35] | 0.483 | 1.41 [0.58; 3.43] | 0.448 | 3.89 [1.6; 9.44] | 0.003 | 2.62 [1.06; 6.48] | 0.037 | 1.87 [0.91; 3.84] | 0.089 | 1.57 [0.75; 3.30] | 0.231 |
Extracapsular spread | 0.98 [0.39; 2.47] | 0.957 | 1.6 [0.7;3.66] | 0.270 | 2.74 [1.08; 6.99] | 0.034 | ||||||
Treatments | ||||||||||||
Interval of >10 weeks between diagnosis and start of RT | 2.22 [0.97; 5.05] | 0.058 | 2.04 [1.05; 3.95] | 0.034 | 0.89 [0.49; 1.61] | 0.693 | ||||||
Interruption RT ≥ 4 days | 1.9 [0.54; 6.74] | 0.320 | 3.76 [1.58; 8.9] | 0.003 | 3.84 [1.71; 8.62] | 0.001 | 1.94 [0.74; 5.08] | 0.177 | ||||
Neck dissection | ||||||||||||
No ND | 1 | 1 | 1 | 1 | ||||||||
Adenectomy | 0.28 [0.03; 2.36] | 0.243 | 0.17 [0.04; 0.75] | 0.019 | 0.20 [0.05; 0.85] | 0.029 | 0.60 [0.19; 1.87] | 0.381 | ||||
Selective ND | 0.47 [0.163; 1.38] | 0.169 | 0.17 [0.07; 0.4] | <0.001 | 0.20 [0.08; 0.51] | <0.001 | 0.57 [0.27; 1.22] | 0.149 | ||||
Modified radical/radical ND | 0.71 [0.26; 1.92] | 0.496 | 0.36 [0.18; 0.73] | 0.005 | 0.40 [0.19; 0.83] | 0.015 | 0.57 [0.26; 1.22] | 0.149 | ||||
Mucosal RT | 0.32 [0.13; 0.76] | 0.010 | 0.32 [0.13; 0.76) | 0.010 | 0.65 [0.29; 1.46] | 0.309 | 0.52 [0.26; 1.07] | 0.076 | ||||
Chemotherapy | 0.52 [0.24; 1.13] | 0.098 | 1.47 [0.73; 2.93] | 0.279 | 1.67 [0.84; 3.33] | 0.142 | ||||||
Neoadjuvant chemotherapy | 1.26 [0.38; 4.19] | 0.712 | 2.74 [1.31; 5.7] | 0.007 | 0.87 [0.32; 2.41] | 0.791 | ||||||
Concomitant chemotherapy | 0.5 [0.23; 1.1] | 0.085 | 1.02 [0.54; 1.94] | 0.941 | 1.49 [0.78; 2.86] | 0.230 |
Prognostic Analysis by Event | Progression-Free Survival | HNCUP-Specific Death | |||||||
---|---|---|---|---|---|---|---|---|---|
Bivariate Analysis | Multivariate Analysis | Bivariate Analysis | Multivariate Analysis | ||||||
HR 95% CI | p-Value | HR 95% CI | p-Value | HR 95% CI | p-Value | HR 95% CI | p-Value | ||
Patients | |||||||||
Male gender | 1.46 [0.85; 2.51] | 0.174 | 3.82 [1.17;12.45] | 0.026 | |||||
Age at diagnosis | 1.03 [1.01; 1.05] | 0.001 | 1 [0.98;1.03] | 0.880 | |||||
Tumors | |||||||||
Initial imaging including a 18-FDG PET-CT | 0.61 [0.4; 0.92] | 0.017 | 0.56 [0.36; 0.86] | 0.008 | 0.43 [0.25;0.74] | 0.002 | 0.44 [0.24; 0.83] | 0.010 | |
Diameter of largest node (cm) | 1.03 [1.01;1.06] | 0.009 | 1.06 [1.03;1.08] | <0.001 | 1.06 [1.03; 1.09] | <.001 | |||
Nodal stage | |||||||||
N1+N2a | 1 | 1 | 1 | 1 | |||||
N2b | 1.82 [1.09; 3.06] | 0.023 | 1.99 [1.18; 3.36] | 0.010 | 1.61 [0.77; 3.35] | 0.206 | 0.97 [0.41; 2.29] | 0.948 | |
N2c+N3 | 3.26 [2.02; 5.25] | <0.001 | 3.00 [1.83; 4.92] | <0.001 | 3.65 [1.87; 7.13] | <0.001 | 2.55 [1.2; 5.15] | 0.009 | |
Extracapsular spread | 2.13 [1.25; 3.63] | 0.006 | 2.18 [1.04; 4.56] | 0.0382 | |||||
Treatments | |||||||||
Time lapse between diagnosis and irradiation | 1.25 [0.87; 1.8] | 0.236 | 1.03 [0.62; 1.68] | 0.923 | |||||
Interruption RT ≥ 4 days | 1.59 [0.84; 3] | 0.155 | 3.31 [1.58; 6.96] | 0.002 | 3.86 [1.75; 8.53] | <0.001 | |||
Neck dissection | |||||||||
No ND | 1 | 1 | 1 | ||||||
Lymphadenectomy | 0.26 [0.11; 0.58] | 0.001 | 0.29 [0.13;0.67] | <0.001 | 0.17 [0.04; 0.78] | 0.022 | |||
Selective ND | 0.28 [0.17; 0.46] | <0.001 | 0.35 [0.21; 0.59] | <0.001 | 0.40 [0.20; 0.80] | 0.010 | |||
Modified radical/radical ND | 0.45 [0.29; 0.71] | <0.001 | 0.43 [0.27; 0.69] | <0.001 | 0.50 [0.26; 0.96] | 0.037 | |||
Mucosal radiotherapy | 0.5 [0.31; 0.81] | 0.005 | 0.41 [0.25; 0.67] | <0.001 | 0.62 [0.32; 1.21] | 0.161 | |||
Chemotherapy | 1.04 [0.71; 1.52] | 0.838 | 1.11 [0.66; 1.86] | 0.690 | |||||
Neoadjuvant | 2.01 [1.21; 3.33] | 0.007 | 2.42 [1.2; 4.84] | 0.013 | 2.45 [1.16; 5.18] | 0.018 | |||
Concomitant | 0.84 [0.58; 1.21] | 0.348 | 0.84 [0.51; 1.39] | 0.502 |
Neck Dissection Extent | No ND | Adenectomy | Selective ND | Modified Radical ND | Radical ND | p-Value |
---|---|---|---|---|---|---|
Acute toxicities | ||||||
Number of patients | 53 | 33 | 116 | 105 | 15 | |
Dysphagia | 19(35.8%) | 6(18.2%) | 34 (29.3%) | 24 (22.9%) | 7 (46.7%) | 0.122 |
Pain | 9(17.3%) | 4(12.1%) | 13 (11.3%) | 14 (13.5%) | 5 (33.3%) | 0.206 |
Late toxicities | ||||||
Number of patients | 50 | 31 | 115 | 99 | 15 | |
Dysphagia | 5(10.0%) | 0 | 6 (5.2%) | 7 (7.1%) | 7 (46.7%) | <0.001 |
Fibrosis | 0 | 1(3.2%) | 10 (8.7%) | 3 (3%) | 6 (40%) | <0.001 |
Pain | 2(4.0%) | 0 | 2 (1.7%) | 1 (1%) | 2 (13.3%) | 0.068 |
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Abu-Shama, Y.; Salleron, J.; Carsuzaa, F.; Sun, X.-S.; Pflumio, C.; Troussier, I.; Petit, C.; Caubet, M.; Beddok, A.; Calugaru, V.; et al. Impact of Neck Dissection in Head and Neck Squamous Cell Carcinomas of Unknown Primary. Cancers 2021, 13, 2416. https://doi.org/10.3390/cancers13102416
Abu-Shama Y, Salleron J, Carsuzaa F, Sun X-S, Pflumio C, Troussier I, Petit C, Caubet M, Beddok A, Calugaru V, et al. Impact of Neck Dissection in Head and Neck Squamous Cell Carcinomas of Unknown Primary. Cancers. 2021; 13(10):2416. https://doi.org/10.3390/cancers13102416
Chicago/Turabian StyleAbu-Shama, Yazan, Julia Salleron, Florent Carsuzaa, Xu-Shan Sun, Carole Pflumio, Idriss Troussier, Claire Petit, Matthieu Caubet, Arnaud Beddok, Valentin Calugaru, and et al. 2021. "Impact of Neck Dissection in Head and Neck Squamous Cell Carcinomas of Unknown Primary" Cancers 13, no. 10: 2416. https://doi.org/10.3390/cancers13102416