Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage
Objectives/Hypothesis The primary objective was to determine the incidence of pathologically positive lymph nodes in clinically N0 larynx cancer patients undergoing salvage surgery following nonsurgical primary therapy. Secondary aims included assessment of the impact of laryngeal subsite and neck d...
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| Veröffentlicht in: | The Laryngoscope 2014-02, Vol.124 (2), p.421-428 |
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| creator | Koss, Shira L. Russell, Marika D. Leem, Ted H. Schiff, Bradley A. Smith, Richard V. |
| description | Objectives/Hypothesis
The primary objective was to determine the incidence of pathologically positive lymph nodes in clinically N0 larynx cancer patients undergoing salvage surgery following nonsurgical primary therapy. Secondary aims included assessment of the impact of laryngeal subsite and neck dissection on disease status and survival.
Study Design
Retrospective chart review.
Methods
Sixty‐eight patients with recurrent laryngeal cancer and no evidence of neck disease who underwent salvage laryngectomy and neck dissection after undergoing failed primary radiotherapy or chemoradiation were examined. Main outcome measures included: standard demographics, primary, clinical, radiologic, and pathologic recurrent TNM stage, laryngeal subsite, nodal neck level, surgical intervention, margin status, disease status, survival, and imaging results.
Results
Fifty‐three men and 15 women, aged 33 to 88 years (mean=62.7 years) with recurrent laryngeal cancer were included. Overall, 28.3% of patients had pathologic nodal disease, with supraglottic cancer showing the highest rate (60%, P=.02). Survival was not associated with laryngectomy type (P=.35). However, on multivariate analysis, laryngeal subsite was significantly predictive of survival with transglottic recurrences demonstrating decreased mean survival (20.7 months, P=.02), and supraglottic recurrences demonstrating prolonged mean survival (37.1 months, P=.03). Metabolic imaging (negative predictive value=0.86) proved more reliable than anatomic imaging (negative predictive value=0.71).
Conclusions
The incidence of pathologically positive lymph nodes in clinically negative patients with recurrent laryngeal carcinoma following nonsurgical therapy warrants standard selective neck dissection. Subsite of recurrence, specifically supraglottis and transglottis, correlates with pathologic neck node positivity and survival. Metabolic imaging proved more reliable than anatomic imaging in negative predictability for nodal disease.
Level of Evidence
4. Laryngoscope, 124:421–428, 2014 |
| doi_str_mv | 10.1002/lary.24005 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_1492680051</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1492680051</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3605-e23719882abe9911c160bdf6c2fca753e4b2bb43185acce95784272d26c5ac1e3</originalsourceid><addsrcrecordid>eNpd0c1O3DAQAGCrKioL7aUPgCz1wiXgn9iJjwi1C1IECFq1PVmOM5uaep3FThZ4e7wscOBky_ONZzxG6CslR5QQduxNfDxiJSHiA5pRwWlRKiU-olkO8qIW7M8u2kvplhBacUE-oV1WcsY5UTOkL62d_IjD0BmPO5fAJMAu4JUZHYQx4Xs3_sML4zx0eFMp9JDlKkKCuM5oCHgKHcR-cKHHaYq9sxkk49emh89oZ2F8gi8v6z769eP7z9Ozormcn5-eNIXlkogCGK-oqmtmWlCKUkslabuFtGxhTSU4lC1r25LTWhhrQYmqLlnFOiZtPqDA99Hh9t5VHO4mSKNeumTBexNgmJKmpWKyziOimX57R2-HKYbc3UYRWUtFeFYHL2pql9DpVXTL_Hr9OroM6Bbc59E8vsUp0ZtP0X6Lc0XdnFz_fd7lnGKb49IID285Jv7XsuKV0L8v5lo28upm3tzoC_4EYSiO-g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1490686903</pqid></control><display><type>article</type><title>Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Koss, Shira L. ; Russell, Marika D. ; Leem, Ted H. ; Schiff, Bradley A. ; Smith, Richard V.</creator><creatorcontrib>Koss, Shira L. ; Russell, Marika D. ; Leem, Ted H. ; Schiff, Bradley A. ; Smith, Richard V.</creatorcontrib><description>Objectives/Hypothesis
The primary objective was to determine the incidence of pathologically positive lymph nodes in clinically N0 larynx cancer patients undergoing salvage surgery following nonsurgical primary therapy. Secondary aims included assessment of the impact of laryngeal subsite and neck dissection on disease status and survival.
Study Design
Retrospective chart review.
Methods
Sixty‐eight patients with recurrent laryngeal cancer and no evidence of neck disease who underwent salvage laryngectomy and neck dissection after undergoing failed primary radiotherapy or chemoradiation were examined. Main outcome measures included: standard demographics, primary, clinical, radiologic, and pathologic recurrent TNM stage, laryngeal subsite, nodal neck level, surgical intervention, margin status, disease status, survival, and imaging results.
Results
Fifty‐three men and 15 women, aged 33 to 88 years (mean=62.7 years) with recurrent laryngeal cancer were included. Overall, 28.3% of patients had pathologic nodal disease, with supraglottic cancer showing the highest rate (60%, P=.02). Survival was not associated with laryngectomy type (P=.35). However, on multivariate analysis, laryngeal subsite was significantly predictive of survival with transglottic recurrences demonstrating decreased mean survival (20.7 months, P=.02), and supraglottic recurrences demonstrating prolonged mean survival (37.1 months, P=.03). Metabolic imaging (negative predictive value=0.86) proved more reliable than anatomic imaging (negative predictive value=0.71).
Conclusions
The incidence of pathologically positive lymph nodes in clinically negative patients with recurrent laryngeal carcinoma following nonsurgical therapy warrants standard selective neck dissection. Subsite of recurrence, specifically supraglottis and transglottis, correlates with pathologic neck node positivity and survival. Metabolic imaging proved more reliable than anatomic imaging in negative predictability for nodal disease.
Level of Evidence
4. Laryngoscope, 124:421–428, 2014</description><identifier>ISSN: 0023-852X</identifier><identifier>EISSN: 1531-4995</identifier><identifier>DOI: 10.1002/lary.24005</identifier><identifier>PMID: 24323309</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; chemotherapy failure ; Dissection ; Female ; Humans ; Laryngeal cancer ; Laryngeal Neoplasms - pathology ; Laryngeal Neoplasms - surgery ; Laryngeal Neoplasms - therapy ; Laryngectomy ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate analysis ; Neck Dissection ; Neoplasm Recurrence, Local - surgery ; positron emission tomography ; Preservation ; radiation failure ; Recurrent or persistent larynx cancer ; Retrospective Studies ; Salvage ; salvage surgery ; Salvage Therapy ; Treatment Failure</subject><ispartof>The Laryngoscope, 2014-02, Vol.124 (2), p.421-428</ispartof><rights>Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3605-e23719882abe9911c160bdf6c2fca753e4b2bb43185acce95784272d26c5ac1e3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Flary.24005$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Flary.24005$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27922,27923,45572,45573</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24323309$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Koss, Shira L.</creatorcontrib><creatorcontrib>Russell, Marika D.</creatorcontrib><creatorcontrib>Leem, Ted H.</creatorcontrib><creatorcontrib>Schiff, Bradley A.</creatorcontrib><creatorcontrib>Smith, Richard V.</creatorcontrib><title>Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage</title><title>The Laryngoscope</title><addtitle>The Laryngoscope</addtitle><description>Objectives/Hypothesis
The primary objective was to determine the incidence of pathologically positive lymph nodes in clinically N0 larynx cancer patients undergoing salvage surgery following nonsurgical primary therapy. Secondary aims included assessment of the impact of laryngeal subsite and neck dissection on disease status and survival.
Study Design
Retrospective chart review.
Methods
Sixty‐eight patients with recurrent laryngeal cancer and no evidence of neck disease who underwent salvage laryngectomy and neck dissection after undergoing failed primary radiotherapy or chemoradiation were examined. Main outcome measures included: standard demographics, primary, clinical, radiologic, and pathologic recurrent TNM stage, laryngeal subsite, nodal neck level, surgical intervention, margin status, disease status, survival, and imaging results.
Results
Fifty‐three men and 15 women, aged 33 to 88 years (mean=62.7 years) with recurrent laryngeal cancer were included. Overall, 28.3% of patients had pathologic nodal disease, with supraglottic cancer showing the highest rate (60%, P=.02). Survival was not associated with laryngectomy type (P=.35). However, on multivariate analysis, laryngeal subsite was significantly predictive of survival with transglottic recurrences demonstrating decreased mean survival (20.7 months, P=.02), and supraglottic recurrences demonstrating prolonged mean survival (37.1 months, P=.03). Metabolic imaging (negative predictive value=0.86) proved more reliable than anatomic imaging (negative predictive value=0.71).
Conclusions
The incidence of pathologically positive lymph nodes in clinically negative patients with recurrent laryngeal carcinoma following nonsurgical therapy warrants standard selective neck dissection. Subsite of recurrence, specifically supraglottis and transglottis, correlates with pathologic neck node positivity and survival. Metabolic imaging proved more reliable than anatomic imaging in negative predictability for nodal disease.
Level of Evidence
4. Laryngoscope, 124:421–428, 2014</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>chemotherapy failure</subject><subject>Dissection</subject><subject>Female</subject><subject>Humans</subject><subject>Laryngeal cancer</subject><subject>Laryngeal Neoplasms - pathology</subject><subject>Laryngeal Neoplasms - surgery</subject><subject>Laryngeal Neoplasms - therapy</subject><subject>Laryngectomy</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Neck Dissection</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>positron emission tomography</subject><subject>Preservation</subject><subject>radiation failure</subject><subject>Recurrent or persistent larynx cancer</subject><subject>Retrospective Studies</subject><subject>Salvage</subject><subject>salvage surgery</subject><subject>Salvage Therapy</subject><subject>Treatment Failure</subject><issn>0023-852X</issn><issn>1531-4995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0c1O3DAQAGCrKioL7aUPgCz1wiXgn9iJjwi1C1IECFq1PVmOM5uaep3FThZ4e7wscOBky_ONZzxG6CslR5QQduxNfDxiJSHiA5pRwWlRKiU-olkO8qIW7M8u2kvplhBacUE-oV1WcsY5UTOkL62d_IjD0BmPO5fAJMAu4JUZHYQx4Xs3_sML4zx0eFMp9JDlKkKCuM5oCHgKHcR-cKHHaYq9sxkk49emh89oZ2F8gi8v6z769eP7z9Ozormcn5-eNIXlkogCGK-oqmtmWlCKUkslabuFtGxhTSU4lC1r25LTWhhrQYmqLlnFOiZtPqDA99Hh9t5VHO4mSKNeumTBexNgmJKmpWKyziOimX57R2-HKYbc3UYRWUtFeFYHL2pql9DpVXTL_Hr9OroM6Bbc59E8vsUp0ZtP0X6Lc0XdnFz_fd7lnGKb49IID285Jv7XsuKV0L8v5lo28upm3tzoC_4EYSiO-g</recordid><startdate>201402</startdate><enddate>201402</enddate><creator>Koss, Shira L.</creator><creator>Russell, Marika D.</creator><creator>Leem, Ted H.</creator><creator>Schiff, Bradley A.</creator><creator>Smith, Richard V.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201402</creationdate><title>Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage</title><author>Koss, Shira L. ; Russell, Marika D. ; Leem, Ted H. ; Schiff, Bradley A. ; Smith, Richard V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3605-e23719882abe9911c160bdf6c2fca753e4b2bb43185acce95784272d26c5ac1e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>chemotherapy failure</topic><topic>Dissection</topic><topic>Female</topic><topic>Humans</topic><topic>Laryngeal cancer</topic><topic>Laryngeal Neoplasms - pathology</topic><topic>Laryngeal Neoplasms - surgery</topic><topic>Laryngeal Neoplasms - therapy</topic><topic>Laryngectomy</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Neck Dissection</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>positron emission tomography</topic><topic>Preservation</topic><topic>radiation failure</topic><topic>Recurrent or persistent larynx cancer</topic><topic>Retrospective Studies</topic><topic>Salvage</topic><topic>salvage surgery</topic><topic>Salvage Therapy</topic><topic>Treatment Failure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Koss, Shira L.</creatorcontrib><creatorcontrib>Russell, Marika D.</creatorcontrib><creatorcontrib>Leem, Ted H.</creatorcontrib><creatorcontrib>Schiff, Bradley A.</creatorcontrib><creatorcontrib>Smith, Richard V.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The Laryngoscope</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Koss, Shira L.</au><au>Russell, Marika D.</au><au>Leem, Ted H.</au><au>Schiff, Bradley A.</au><au>Smith, Richard V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage</atitle><jtitle>The Laryngoscope</jtitle><addtitle>The Laryngoscope</addtitle><date>2014-02</date><risdate>2014</risdate><volume>124</volume><issue>2</issue><spage>421</spage><epage>428</epage><pages>421-428</pages><issn>0023-852X</issn><eissn>1531-4995</eissn><abstract>Objectives/Hypothesis
The primary objective was to determine the incidence of pathologically positive lymph nodes in clinically N0 larynx cancer patients undergoing salvage surgery following nonsurgical primary therapy. Secondary aims included assessment of the impact of laryngeal subsite and neck dissection on disease status and survival.
Study Design
Retrospective chart review.
Methods
Sixty‐eight patients with recurrent laryngeal cancer and no evidence of neck disease who underwent salvage laryngectomy and neck dissection after undergoing failed primary radiotherapy or chemoradiation were examined. Main outcome measures included: standard demographics, primary, clinical, radiologic, and pathologic recurrent TNM stage, laryngeal subsite, nodal neck level, surgical intervention, margin status, disease status, survival, and imaging results.
Results
Fifty‐three men and 15 women, aged 33 to 88 years (mean=62.7 years) with recurrent laryngeal cancer were included. Overall, 28.3% of patients had pathologic nodal disease, with supraglottic cancer showing the highest rate (60%, P=.02). Survival was not associated with laryngectomy type (P=.35). However, on multivariate analysis, laryngeal subsite was significantly predictive of survival with transglottic recurrences demonstrating decreased mean survival (20.7 months, P=.02), and supraglottic recurrences demonstrating prolonged mean survival (37.1 months, P=.03). Metabolic imaging (negative predictive value=0.86) proved more reliable than anatomic imaging (negative predictive value=0.71).
Conclusions
The incidence of pathologically positive lymph nodes in clinically negative patients with recurrent laryngeal carcinoma following nonsurgical therapy warrants standard selective neck dissection. Subsite of recurrence, specifically supraglottis and transglottis, correlates with pathologic neck node positivity and survival. Metabolic imaging proved more reliable than anatomic imaging in negative predictability for nodal disease.
Level of Evidence
4. Laryngoscope, 124:421–428, 2014</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>24323309</pmid><doi>10.1002/lary.24005</doi><tpages>8</tpages></addata></record> |
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| ispartof | The Laryngoscope, 2014-02, Vol.124 (2), p.421-428 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Aged Aged, 80 and over chemotherapy failure Dissection Female Humans Laryngeal cancer Laryngeal Neoplasms - pathology Laryngeal Neoplasms - surgery Laryngeal Neoplasms - therapy Laryngectomy Lymphatic Metastasis Male Middle Aged Multivariate analysis Neck Dissection Neoplasm Recurrence, Local - surgery positron emission tomography Preservation radiation failure Recurrent or persistent larynx cancer Retrospective Studies Salvage salvage surgery Salvage Therapy Treatment Failure |
| title | Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage |
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