Universität zu Köln

Ebrahimi, Ardalan, Clark, Jonathan R., Amit, M., Yen, T. C., Liao, Chun-Ta, Kowalski, Luis P., Kreppel, Matthias, Cernea, Claudio R., Bachar, Gideon, Villaret, Andrea Bolzoni, Fliss, Dan, Fridman, Eran, Robbins, K. T., Shah, Jatin P., Patel, Snehal G. and Gil, Ziv (2014). Minimum Nodal Yield in Oral Squamous Cell Carcinoma: Defining the Standard of Care in a Multicenter International Pooled Validation Study. Ann. Surg. Oncol., 21 (9). S. 3049 - 3056. NEW YORK: SPRINGER. ISSN 1534-4681

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Abstract

Purpose. There is evidence to suggest that a nodal yield <18 is an independent prognostic factor in patients with clinically node negative (cN0) oral squamous cell carcinoma (SCC) treated with elective neck dissection (END). We sought to evaluate this hypothesis with external validation and to investigate for heterogeneity between institutions. Patients and Methods. We analyzed pooled individual data from 1,567 patients treated at nine comprehensive cancer centers worldwide between 1970 and 2011. Nodal yield was assessed with Cox proportional hazard models, stratified by study center, and adjusted for age, sex, pathological T and N stage, margin status, extracapsular nodal spread, time period of primary treatment, and adjuvant therapy. Two-stage random-effects meta-analyses were used to investigate for heterogeneity between institutions. Results. In multivariable analyses of patients undergoing selective neck dissection, nodal yield <18 was associated with reduced overall survival [hazard ratio (HR) 1.69; 95 % confidence interval (CI) 1.22-2.34; p = 0.002] and disease-specific survival (HR 1.88; 95 % CI 1.21-2.91; p = 0.005), and increased risk of locoregional recurrence (HR 1.53; 95 % CI 1.04-2.26; p = 0.032). Despite significant differences between institutions in terms of patient clinicopathological factors, nodal yield, and outcomes, random-effects meta-analysis demonstrated no evidence of heterogeneity between centers in regards to the impact of nodal yield on disease-specific survival (p = 0.663; I-2 statistic = 0). Conclusion. Our data confirm that nodal yield is a robust independent prognostic factor in patients undergoing END for cN0 oral SCC, and may be applied irrespective of the underlying patient population and treating institution. A minimum adequate lymphadenectomy in this setting should include at least 18 nodes.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Ebrahimi, Ardalan UNSPECIFIED UNSPECIFIED UNSPECIFIED Clark, Jonathan R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Amit, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Yen, T. C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Liao, Chun-Ta UNSPECIFIED UNSPECIFIED UNSPECIFIED Kowalski, Luis P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kreppel, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Cernea, Claudio R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bachar, Gideon UNSPECIFIED UNSPECIFIED UNSPECIFIED Villaret, Andrea Bolzoni UNSPECIFIED UNSPECIFIED UNSPECIFIED Fliss, Dan UNSPECIFIED UNSPECIFIED UNSPECIFIED Fridman, Eran UNSPECIFIED UNSPECIFIED UNSPECIFIED Robbins, K. T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Shah, Jatin P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Patel, Snehal G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gil, Ziv UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-429975
DOI:	10.1245/s10434-014-3702-x
Journal or Publication Title:	Ann. Surg. Oncol.
Volume:	21
Number:	9
Page Range:	S. 3049 - 3056
Date:	2014
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1534-4681
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ELECTIVE NECK DISSECTION; LYMPH-NODES; COLON-CANCER; RADICAL CYSTECTOMY; ESOPHAGEAL CANCER; SURVIVAL; NUMBER; METAANALYSIS; RESECTION; EXTENT Multiple languages Oncology; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/42997