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Vol. 69. Issue 3.
Pages 156-164 (May - June 2018)
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Vol. 69. Issue 3.
Pages 156-164 (May - June 2018)
Original article
DOI: 10.1016/j.otoeng.2017.07.002
Prognostic Significance of Extranodal Extension in Head and Neck Squamous Cell Carcinoma cN0 Patients With Occult Metastatic Neck Nodes
Significado pronóstico de la extensión extranodal en pacientes con carcinomas escamosos de cabeza y cuello cN0 con metástasis ganglionares ocultas
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Joan Lopa,
Corresponding author
lopgros@gmail.com

Corresponding author.
, Antoni Rigób, Alberto Codinab, Julia de Juanb, Miquel Querb, Xavier Leónb,c
a Servicio de Otorrinolaringología, Hospital Josep Trueta, Girona, Spain
b Servicio de Otorrinolaringología, Hospital de Sant Pau, Barcelona, Spain
c Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
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Figures (2)
Tables (6)
Table 1. Comparison of the Classification Criteria of the Node Category Between the Seventh and Eighth Editions of TNM.13
Table 2. Features of the Patients Included in the Study.
Table 3. Percentage of Patients With Occult Metastatic Neck Nodes and With Extranodal Extension According to the Location, Extension and Histological Grade of the Primary Tumour.
Table 4. Local, Regional or Remote Recurrence-Free Survival According to Lymph Node Status.
Table 5. Result of a Multivariate Analysis That Examined Specific Survival as a Dependent Variable.
Table 6. cN0 With Occult Metastatic Neck Nodes and With Occult Metastatic Neck Nodes With Extranodal Extension in Different Published Series.
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Abstract
Introduction and objectives

Extranodal extension in nodal metastases is an independent adverse prognostic factor in head and neck squamous cell carcinoma patients. However, few studies specifically address the subgroup of patients with no clinical evidence of nodal disease.

Material and methods

We retrospectively analysed data from 348 head and neck squamous cell carcinoma patients without any previous treatment and lacking clinical or radiological evidence of neck node metastases during the initial workup, treated with an elective neck dissection between 1992 and 2014. The incidence of occult metastatic neck nodes with extranodal extension and the impact of extranodal extension in survival were evaluated.

Results

The proportion of patients with occult neck node metastases was 33%. Of these, 23.5% had at least one metastatic neck node with extranodal extension. There were significant differences in the disease-specific survival rate according to neck node status. Five-year disease-specific survival for patients without histopathological metastases was 90%, for patients with occult neck node metastases without extranodal extension it was 71.2%, and for patients with occult neck node metastases with extranodal extension it was 25.9% (P=.0001). The multivariate analysis revealed that the presence of occult node metastases with extranodal extension was the factor with strongest impact on survival. The inclusion of the extranodal extension as a criterion of histopathological evaluation in the 8th TNM classification edition improves the prognostic capacity compared to previous TNM editions.

Conclusions

Appearance of metastatic neck nodes with extranodal extension is an adverse prognostic factor in head and neck squamous cell carcinoma patients without clinical evidence of regional disease during the initial workup of the tumour.

Keywords:
Squamous cell carcinoma of the head and neck
Occult neck node metastases
Extranodal extension
CN0
Elective neck dissection
Resumen
Introducción y objetivos

La presencia de extensión extranodal en adenopatías metastásicas de pacientes con carcinoma escamoso de cabeza y cuello es un reconocido factor de mal pronóstico. Sin embargo, pocos estudios analizan específicamente su significado en pacientes sin evidencia clínica de extensión ganglionar en el momento del diagnóstico inicial.

Material y métodos

Estudio retrospectivo de 348 pacientes con carcinoma escamoso de cabeza y cuello cN0 tratados con un vaciamiento cervical electivo. Se evaluó la presencia de metástasis ganglionares ocultas con extensión extranodal y se analizó su impacto sobre la supervivencia.

Resultados

El porcentaje de pacientes con metástasis ganglionares ocultas fue del 33%. De estos, un 23,5% presentaron al menos una adenopatía metastásica con extensión extranodal. Existieron diferencias significativas en la supervivencia específica en función del estatus ganglionar. La supervivencia a los 5 años para los pacientes sin afectación ganglionar patológica fue del 90%, para aquellos con metástasis ganglionares ocultas sin extensión extranodal, del 71,2%, y para los pacientes con metástasis ganglionares ocultas con extensión extranodal, del 25,9% (p=0,0001). En un estudio multivariante la presencia de metástasis ganglionares ocultas con extensión extranodal fue el factor relacionado de forma más importante con la supervivencia. La incorporación de la extensión extranodal como criterio de clasificación histopatológico en la octava edición del TNM mejoró la capacidad pronóstica en relación con las ediciones anteriores.

Conclusiones

La presencia de adenopatías metastásicas con extensión extranodal es un factor de mal pronóstico en pacientes con carcinoma escamoso de cabeza y cuello sin evidencia clínica de afectación regional en el momento del diagnóstico de la enfermedad.

Palabras clave:
Carcinoma escamoso de cabeza y cuello
Metástasis ganglionar oculta
Extensión extranodal
CN0
Vaciamiento cervical electivo

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