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Frequency and Consequences of Cervical Lymph Node Overstaging in Head and Neck Carcinoma
Clinical lymph node staging in head and neck carcinoma (HNC) is fraught with uncertainties. Established clinical algorithms are available for the problem of occult cervical metastases. Much less is known about clinical lymph node overstaging. We identified HNC patients clinically classified as lymph...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9221862/ https://www.ncbi.nlm.nih.gov/pubmed/35741189 http://dx.doi.org/10.3390/diagnostics12061377 |
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author | Schartinger, Volker Hans Dejaco, Daniel Fischer, Natalie Lettenbichler-Haug, Anna Anegg, Maria Santer, Matthias Schmutzhard, Joachim Kofler, Barbara Vorbach, Samuel Widmann, Gerlig Riechelmann, Herbert |
author_facet | Schartinger, Volker Hans Dejaco, Daniel Fischer, Natalie Lettenbichler-Haug, Anna Anegg, Maria Santer, Matthias Schmutzhard, Joachim Kofler, Barbara Vorbach, Samuel Widmann, Gerlig Riechelmann, Herbert |
author_sort | Schartinger, Volker Hans |
collection | PubMed |
description | Clinical lymph node staging in head and neck carcinoma (HNC) is fraught with uncertainties. Established clinical algorithms are available for the problem of occult cervical metastases. Much less is known about clinical lymph node overstaging. We identified HNC patients clinically classified as lymph node positive (cN+), in whom surgical neck dissection (ND) specimens were histopathologically negative (pN0) and in addition the subgroup, in whom an originally planned postoperative radiotherapy (PORT) was omitted. We compared these patients with surgically treated patients with clinically and histopathologically negative neck (cN0/pN0), who had received selective ND. Using a fuzzy matching algorithm, we identified patients with closely similar patient and disease characteristics, who had received primary definitive radiotherapy (RT) with or without systemic therapy (RT ± ST). Of the 980 patients with HNC, 292 received a ND as part of primary treatment. In 128/292 patients with cN0 neck, ND was elective, and in 164 patients with clinically positive neck (cN+), ND was therapeutic. In 43/164 cN+ patients, ND was histopathologically negative (cN+/pN−). In 24 of these, initially planned PORT was omitted. Overall, survival did not differ from the cN0/pN0 and primary RT ± ST control groups. However, more RT ± ST patients had functional problems with nutrition (p = 0.002). Based on these data, it can be estimated that lymph node overstaging is 26% (95% CI: 20% to 34%). In 15% (95% CI: 10% to 21%) of surgically treated cN+ HNC patients, treatment can be de-escalated without the affection of survival. |
format | Online Article Text |
id | pubmed-9221862 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-92218622022-06-24 Frequency and Consequences of Cervical Lymph Node Overstaging in Head and Neck Carcinoma Schartinger, Volker Hans Dejaco, Daniel Fischer, Natalie Lettenbichler-Haug, Anna Anegg, Maria Santer, Matthias Schmutzhard, Joachim Kofler, Barbara Vorbach, Samuel Widmann, Gerlig Riechelmann, Herbert Diagnostics (Basel) Article Clinical lymph node staging in head and neck carcinoma (HNC) is fraught with uncertainties. Established clinical algorithms are available for the problem of occult cervical metastases. Much less is known about clinical lymph node overstaging. We identified HNC patients clinically classified as lymph node positive (cN+), in whom surgical neck dissection (ND) specimens were histopathologically negative (pN0) and in addition the subgroup, in whom an originally planned postoperative radiotherapy (PORT) was omitted. We compared these patients with surgically treated patients with clinically and histopathologically negative neck (cN0/pN0), who had received selective ND. Using a fuzzy matching algorithm, we identified patients with closely similar patient and disease characteristics, who had received primary definitive radiotherapy (RT) with or without systemic therapy (RT ± ST). Of the 980 patients with HNC, 292 received a ND as part of primary treatment. In 128/292 patients with cN0 neck, ND was elective, and in 164 patients with clinically positive neck (cN+), ND was therapeutic. In 43/164 cN+ patients, ND was histopathologically negative (cN+/pN−). In 24 of these, initially planned PORT was omitted. Overall, survival did not differ from the cN0/pN0 and primary RT ± ST control groups. However, more RT ± ST patients had functional problems with nutrition (p = 0.002). Based on these data, it can be estimated that lymph node overstaging is 26% (95% CI: 20% to 34%). In 15% (95% CI: 10% to 21%) of surgically treated cN+ HNC patients, treatment can be de-escalated without the affection of survival. MDPI 2022-06-02 /pmc/articles/PMC9221862/ /pubmed/35741189 http://dx.doi.org/10.3390/diagnostics12061377 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Schartinger, Volker Hans Dejaco, Daniel Fischer, Natalie Lettenbichler-Haug, Anna Anegg, Maria Santer, Matthias Schmutzhard, Joachim Kofler, Barbara Vorbach, Samuel Widmann, Gerlig Riechelmann, Herbert Frequency and Consequences of Cervical Lymph Node Overstaging in Head and Neck Carcinoma |
title | Frequency and Consequences of Cervical Lymph Node Overstaging in Head and Neck Carcinoma |
title_full | Frequency and Consequences of Cervical Lymph Node Overstaging in Head and Neck Carcinoma |
title_fullStr | Frequency and Consequences of Cervical Lymph Node Overstaging in Head and Neck Carcinoma |
title_full_unstemmed | Frequency and Consequences of Cervical Lymph Node Overstaging in Head and Neck Carcinoma |
title_short | Frequency and Consequences of Cervical Lymph Node Overstaging in Head and Neck Carcinoma |
title_sort | frequency and consequences of cervical lymph node overstaging in head and neck carcinoma |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9221862/ https://www.ncbi.nlm.nih.gov/pubmed/35741189 http://dx.doi.org/10.3390/diagnostics12061377 |
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