Amit, Moran, Yen, Tzu Chen, Liao, Chun Ta, Chaturvedi, Pankaj, Agarwal, Jai Prakash, Kowalski, Luiz Paulo, Kohler, Hugo F., Ebrahimi, Ardalan, Clark, Jonathan R., Cernea, Claudio Roberto ORCID: 0000-0001-5899-0535, Brandao, Jose S., Kreppel, Matthias, Zoeller, Joachim E., Leider-Trejo, Leonor, Bachar, Gideon, Shpitzer, Thomas, Bolzoni, Andrea Villaret, Patel, Raj P., Jonnalagadda, Sashikanth, Robbins, Thomas Kevin, Shah, Jatin P., Patel, Snehal G. and Gil, Ziv (2014). The Origin of Regional Failure in Oral Cavity Squamous Cell Carcinoma With Pathologically Negative Neck Metastases. JAMA Otolaryngol-Head Neck Surg., 140 (12). S. 1130 - 1138. CHICAGO: AMER MEDICAL ASSOC. ISSN 2168-619X

Full text not available from this repository.

Abstract

IMPORTANCE Squamous cell carcinoma of the oral cavity (OSCC) is a common malignant tumor worldwide. OBJECTIVE To determine if regional failure in patients with OSCC and pathologically negative neck nodes (pN-) is due to an incomplete sampling procedure during surgery. DESIGN, SETTING, AND PARTICIPANTS We retrospectively reviewed the medical records of 2258 patients from 11 cancer centers worldwide who underwent neck dissection for OSCC (1990-2011) and who were pN-. Of those, 345 had clinical evidence of nodal metastases (cN+) on radiologic workup. The neck specimens were available for reanalysis in 193 patients. Survival rates were calculated using the Kaplan-Meier graphs and analyzed by multivariable analysis. MAIN OUTCOMES AND MEASURES Five-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). RESULTS Resectioning and analysis of the neck dissection specimens in the cN+/pN- subgroup revealed false-negative results in 29 (15%) of 193 patients. The negative predictive value of the initial pathologic examination was 85%. The 5-year OS and DSS in the cN-/pN- group were 77.6% and 87.2%, respectively. The 5-year OS and DSS of the cN+/pN- group were 62.6% and 78.5%, respectively (P < .001). In multivariable analysis, cN+ classification was significantly associated with poor OS (hazard ratio [HR], 1.7; 95% CI, 1.1-3.8; P = .03) and poor DSS (HR, 1.46; 95% CI, 1.1-4.1; P = .04). A cN+ classification was associated with lower DFS (66.3% vs 76.2%; P = .05) and lower regional recurrence-free survival (68.6% vs 78.8%; P = .02) but not with local (P = .20) or distant recurrence (P = .80). CONCLUSIONS AND RELEVANCE Pathologic staging underestimates the incidence of nodal metastases in cN+ disease. After correction for pathologically missed nodal metastases, radiologic evidence of neck nodes is an independent predictor of outcome, suggesting that traditional sampling during surgery might miss metastases, and this fact might explain the origin of treatment failure in these patients.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Amit, MoranUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Yen, Tzu ChenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Liao, Chun TaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chaturvedi, PankajUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Agarwal, Jai PrakashUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kowalski, Luiz PauloUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kohler, Hugo F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ebrahimi, ArdalanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Clark, Jonathan R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cernea, Claudio RobertoUNSPECIFIEDorcid.org/0000-0001-5899-0535UNSPECIFIED
Brandao, Jose S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kreppel, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zoeller, Joachim E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Leider-Trejo, LeonorUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bachar, GideonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shpitzer, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bolzoni, Andrea VillaretUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Patel, Raj P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jonnalagadda, SashikanthUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Robbins, Thomas KevinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shah, Jatin P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Patel, Snehal G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gil, ZivUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-421405
DOI: 10.1001/jamaoto.2014.1539
Journal or Publication Title: JAMA Otolaryngol-Head Neck Surg.
Volume: 140
Number: 12
Page Range: S. 1130 - 1138
Date: 2014
Publisher: AMER MEDICAL ASSOC
Place of Publication: CHICAGO
ISSN: 2168-619X
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
LYMPH-NODE METASTASES; SIGNIFICANT PREDICTOR; HEAD; CANCER; MICROMETASTASES; CHEMOTHERAPY; RADIOTHERAPY; METAANALYSIS; DISSECTIONS; TOMOGRAPHYMultiple languages
Otorhinolaryngology; SurgeryMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/42140

Downloads

Downloads per month over past year

Altmetric

Export

Actions (login required)

View Item View Item