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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...

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Autores principales: Schartinger, Volker Hans, Dejaco, Daniel, Fischer, Natalie, Lettenbichler-Haug, Anna, Anegg, Maria, Santer, Matthias, Schmutzhard, Joachim, Kofler, Barbara, Vorbach, Samuel, Widmann, Gerlig, Riechelmann, Herbert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
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.
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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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