Minimum Nodal Yield in Oral Squamous Cell Carcinoma: Defining the Standard of Care in a Multicenter International Pooled Validation Study
Purpose There is evidence to suggest that a nodal yield
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| Veröffentlicht in: | Annals of surgical oncology 2014-09, Vol.21 (9), p.3049-3055 |
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| creator | 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. Gil, Ziv |
| description | Purpose
There is evidence to suggest that a nodal yield |
| doi_str_mv | 10.1245/s10434-014-3702-x |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1551612148</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1551612148</sourcerecordid><originalsourceid>FETCH-LOGICAL-c442t-1b8815f0dd138fb5c8e5d9f3eef659979d76585a6c85e65d2d154db6fd75542c3</originalsourceid><addsrcrecordid>eNp1kdtqFTEYhYMotlYfwBsJeOPN1Jwn451sDy20VqgKXoXsyZ-akknaZAbaR_CtzXRXEcGbHP58a4XFQug5JYeUCfm6UiK46AgVHe8J624eoH0q20QoTR-2M1G6G5iSe-hJrZeE0J4T-RjtMdEzrRnfRz9PQwrTMuFP2dmIvweIDoeEz0q7nV8vdspLxRuIEW9sGUPKk32D34FvsnSB5x-Az2ebnC0OZ78ysMotPl3iHEZIMxR8vK7JziGn5vo55wgOf7MxuLtZc1jc7VP0yNtY4dn9foC-fnj_ZXPUnZx9PN68PelGIdjc0a3WVHriHOXab-WoQbrBcwCv5DD0g-uV1NKqUUtQ0jFHpXBb5V0vpWAjP0Cvdr5XJV8vUGczhTq2gDZBy2qolFRRRoVu6Mt_0Mu8tCDxjiKD4qznjaI7aiy51gLeXJUw2XJrKDFrT2bXk2k9mbUnc9M0L-6dl-0E7o_idzENYDugtqd0AeWvr__r-gsuSp5q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1550963273</pqid></control><display><type>article</type><title>Minimum Nodal Yield in Oral Squamous Cell Carcinoma: Defining the Standard of Care in a Multicenter International Pooled Validation Study</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>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. ; Gil, Ziv</creator><creatorcontrib>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. ; Gil, Ziv</creatorcontrib><description>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.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-014-3702-x</identifier><identifier>PMID: 24728823</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Aged ; Carcinoma, Squamous Cell - mortality ; Carcinoma, Squamous Cell - secondary ; Carcinoma, Squamous Cell - surgery ; Female ; Follow-Up Studies ; Head and Neck Oncology ; Humans ; International Agencies ; Lymph Node Excision - standards ; Lymphatic Metastasis ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mouth Neoplasms - mortality ; Mouth Neoplasms - pathology ; Mouth Neoplasms - surgery ; Neoplasm Recurrence, Local - mortality ; Neoplasm Recurrence, Local - pathology ; Neoplasm Recurrence, Local - surgery ; Neoplasm Staging ; Oncology ; Prognosis ; Standard of Care ; Surgery ; Surgical Oncology ; Survival Rate</subject><ispartof>Annals of surgical oncology, 2014-09, Vol.21 (9), p.3049-3055</ispartof><rights>Society of Surgical Oncology 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-1b8815f0dd138fb5c8e5d9f3eef659979d76585a6c85e65d2d154db6fd75542c3</citedby><cites>FETCH-LOGICAL-c442t-1b8815f0dd138fb5c8e5d9f3eef659979d76585a6c85e65d2d154db6fd75542c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-014-3702-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-014-3702-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24728823$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ebrahimi, Ardalan</creatorcontrib><creatorcontrib>Clark, Jonathan R.</creatorcontrib><creatorcontrib>Amit, M.</creatorcontrib><creatorcontrib>Yen, T. C.</creatorcontrib><creatorcontrib>Liao, Chun-Ta</creatorcontrib><creatorcontrib>Kowalski, Luis P.</creatorcontrib><creatorcontrib>Kreppel, Matthias</creatorcontrib><creatorcontrib>Cernea, Claudio R.</creatorcontrib><creatorcontrib>Bachar, Gideon</creatorcontrib><creatorcontrib>Villaret, Andrea Bolzoni</creatorcontrib><creatorcontrib>Fliss, Dan</creatorcontrib><creatorcontrib>Fridman, Eran</creatorcontrib><creatorcontrib>Robbins, K. T.</creatorcontrib><creatorcontrib>Shah, Jatin P.</creatorcontrib><creatorcontrib>Patel, Snehal G.</creatorcontrib><creatorcontrib>Gil, Ziv</creatorcontrib><title>Minimum Nodal Yield in Oral Squamous Cell Carcinoma: Defining the Standard of Care in a Multicenter International Pooled Validation Study</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>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.</description><subject>Aged</subject><subject>Carcinoma, Squamous Cell - mortality</subject><subject>Carcinoma, Squamous Cell - secondary</subject><subject>Carcinoma, Squamous Cell - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Head and Neck Oncology</subject><subject>Humans</subject><subject>International Agencies</subject><subject>Lymph Node Excision - standards</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mouth Neoplasms - mortality</subject><subject>Mouth Neoplasms - pathology</subject><subject>Mouth Neoplasms - surgery</subject><subject>Neoplasm Recurrence, Local - mortality</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>Neoplasm Staging</subject><subject>Oncology</subject><subject>Prognosis</subject><subject>Standard of Care</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival Rate</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kdtqFTEYhYMotlYfwBsJeOPN1Jwn451sDy20VqgKXoXsyZ-akknaZAbaR_CtzXRXEcGbHP58a4XFQug5JYeUCfm6UiK46AgVHe8J624eoH0q20QoTR-2M1G6G5iSe-hJrZeE0J4T-RjtMdEzrRnfRz9PQwrTMuFP2dmIvweIDoeEz0q7nV8vdspLxRuIEW9sGUPKk32D34FvsnSB5x-Az2ebnC0OZ78ysMotPl3iHEZIMxR8vK7JziGn5vo55wgOf7MxuLtZc1jc7VP0yNtY4dn9foC-fnj_ZXPUnZx9PN68PelGIdjc0a3WVHriHOXab-WoQbrBcwCv5DD0g-uV1NKqUUtQ0jFHpXBb5V0vpWAjP0Cvdr5XJV8vUGczhTq2gDZBy2qolFRRRoVu6Mt_0Mu8tCDxjiKD4qznjaI7aiy51gLeXJUw2XJrKDFrT2bXk2k9mbUnc9M0L-6dl-0E7o_idzENYDugtqd0AeWvr__r-gsuSp5q</recordid><startdate>20140901</startdate><enddate>20140901</enddate><creator>Ebrahimi, Ardalan</creator><creator>Clark, Jonathan R.</creator><creator>Amit, M.</creator><creator>Yen, T. C.</creator><creator>Liao, Chun-Ta</creator><creator>Kowalski, Luis P.</creator><creator>Kreppel, Matthias</creator><creator>Cernea, Claudio R.</creator><creator>Bachar, Gideon</creator><creator>Villaret, Andrea Bolzoni</creator><creator>Fliss, Dan</creator><creator>Fridman, Eran</creator><creator>Robbins, K. T.</creator><creator>Shah, Jatin P.</creator><creator>Patel, Snehal G.</creator><creator>Gil, Ziv</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20140901</creationdate><title>Minimum Nodal Yield in Oral Squamous Cell Carcinoma: Defining the Standard of Care in a Multicenter International Pooled Validation Study</title><author>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. ; Gil, Ziv</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c442t-1b8815f0dd138fb5c8e5d9f3eef659979d76585a6c85e65d2d154db6fd75542c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Carcinoma, Squamous Cell - mortality</topic><topic>Carcinoma, Squamous Cell - secondary</topic><topic>Carcinoma, Squamous Cell - surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Head and Neck Oncology</topic><topic>Humans</topic><topic>International Agencies</topic><topic>Lymph Node Excision - standards</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mouth Neoplasms - mortality</topic><topic>Mouth Neoplasms - pathology</topic><topic>Mouth Neoplasms - surgery</topic><topic>Neoplasm Recurrence, Local - mortality</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>Neoplasm Staging</topic><topic>Oncology</topic><topic>Prognosis</topic><topic>Standard of Care</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ebrahimi, Ardalan</creatorcontrib><creatorcontrib>Clark, Jonathan R.</creatorcontrib><creatorcontrib>Amit, M.</creatorcontrib><creatorcontrib>Yen, T. C.</creatorcontrib><creatorcontrib>Liao, Chun-Ta</creatorcontrib><creatorcontrib>Kowalski, Luis P.</creatorcontrib><creatorcontrib>Kreppel, Matthias</creatorcontrib><creatorcontrib>Cernea, Claudio R.</creatorcontrib><creatorcontrib>Bachar, Gideon</creatorcontrib><creatorcontrib>Villaret, Andrea Bolzoni</creatorcontrib><creatorcontrib>Fliss, Dan</creatorcontrib><creatorcontrib>Fridman, Eran</creatorcontrib><creatorcontrib>Robbins, K. T.</creatorcontrib><creatorcontrib>Shah, Jatin P.</creatorcontrib><creatorcontrib>Patel, Snehal G.</creatorcontrib><creatorcontrib>Gil, Ziv</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ebrahimi, Ardalan</au><au>Clark, Jonathan R.</au><au>Amit, M.</au><au>Yen, T. C.</au><au>Liao, Chun-Ta</au><au>Kowalski, Luis P.</au><au>Kreppel, Matthias</au><au>Cernea, Claudio R.</au><au>Bachar, Gideon</au><au>Villaret, Andrea Bolzoni</au><au>Fliss, Dan</au><au>Fridman, Eran</au><au>Robbins, K. T.</au><au>Shah, Jatin P.</au><au>Patel, Snehal G.</au><au>Gil, Ziv</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Minimum Nodal Yield in Oral Squamous Cell Carcinoma: Defining the Standard of Care in a Multicenter International Pooled Validation Study</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2014-09-01</date><risdate>2014</risdate><volume>21</volume><issue>9</issue><spage>3049</spage><epage>3055</epage><pages>3049-3055</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><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.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>24728823</pmid><doi>10.1245/s10434-014-3702-x</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2014-09, Vol.21 (9), p.3049-3055 |
| issn | 1068-9265 1534-4681 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1551612148 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Aged Carcinoma, Squamous Cell - mortality Carcinoma, Squamous Cell - secondary Carcinoma, Squamous Cell - surgery Female Follow-Up Studies Head and Neck Oncology Humans International Agencies Lymph Node Excision - standards Lymphatic Metastasis Male Medicine Medicine & Public Health Middle Aged Mouth Neoplasms - mortality Mouth Neoplasms - pathology Mouth Neoplasms - surgery Neoplasm Recurrence, Local - mortality Neoplasm Recurrence, Local - pathology Neoplasm Recurrence, Local - surgery Neoplasm Staging Oncology Prognosis Standard of Care Surgery Surgical Oncology Survival Rate |
| title | Minimum Nodal Yield in Oral Squamous Cell Carcinoma: Defining the Standard of Care in a Multicenter International Pooled Validation Study |
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