The survival benefit of lymph node dissection in resected T1-2, cN0 supraglottic cancer: A population-based propensity score matching analysis

Cervical lymph node dissection fails to improve survival in T2N0M0 glottic squamous cell carcinoma: a large-scale real-world study

OBJECTIVE

This study aimed to evaluate the therapeutic efficacy of cervical lymph node dissection in patients with T2N0M0 glottic squamous cell carcinoma.

METHODS

Among 260,068 head and neck cancer patients, 861 cases of T2N0M0 glottic squamous cell carcinoma were selected, of which 113 underwent selective lymph node dissection, and 748 did not receive dissection. The overall survival rates and disease-specific survival rates were compared between the two groups to assess efficacy.

RESULTS

There was no significant difference in overall survival rates (median survival time of 57 months vs. 62 months, p = 0.34) and disease-specific survival rates (p = 0.79) between the two groups. Patients aged ≥ 60 years were at a higher risk, whereas neck dissection, gender, and degree of differentiation did not show significant risk differences in this study.

CONCLUSION

Cervical lymph node dissection in patients with T2N0 glottic squamous cell carcinoma did not demonstrate a significant advantage in survival rates.

Bilateral Neck Dissection in cN0 Supraglottic Squamous Cell Carcinoma: Essential or Not?

OBJECTIVE

There is controversy regarding bilateral neck dissection for cN0 supraglottic squamous cell carcinoma. This study aimed to explore the risk factor of occult isolated contralateral/bilateral metastasis in cN0 supraglottic squamous cell carcinoma and help clinicians better make assessments for these patients.

METHOD

PubMed, the Cochrane Library, CNKI, and CBM were systematically searched for studies on occult lymph node metastasis in cN0 supraglottic squamous cell carcinoma from the inception of each database to May 30, 2024. All patients with supraglottic squamous cell carcinoma and a clinical N0 neck, who had complete records of neck lymph node metastasis, were included in the study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline was followed to extract data. Data were pooled using a random-effects generalized linear mixed model with 95% confidence intervals (CIs). The risk of occult isolated contralateral/bilateral metastatic lymph nodes was analyzed.

RESULTS

Fifteen studies including 1609 patients with cN0 supraglottic squamous cell carcinoma were analyzed. The pooled risk of occult isolated contralateral/bilateral metastasis was 7.49% (95% CI: 5.65%-9.87%; I2 = 57%). For Type A tumors, the risk was 4.14% (95% CI: 2%-64%; I2 = 81%), 6.74% for Type B (95% CI: 2.27%-18.33%, I2 = 82%), and 13.62% for Type C (95% CI: 5.82%-28.66%, I2 = 69%). For T1-T2 patients, the risk was 5.18% (95% CI: 2%-64%; I2 = 81%), and 8.73% (95% CI: 5.92%-12.69%, I2 = 0%)for T3-T4 patients. When ipsilateral pN+ was present, the risk increased to 20.97% (95% CI: 16.09%-26.85%, I2 = 29%).

CONCLUSIONS

Contralateral neck dissection is recommended for Type C patients. Pathologically ipsilateral metastasis confirmed patients should receive contralateral neck dissection, radiotherapy, or even active surveillance follow-up.

Development and validation of a machine learning model to predict the risk of lymph node metastasis in early-stage supraglottic laryngeal cancer

Background

Cervical lymph node metastasis (LNM) is a significant factor that leads to a poor prognosis in laryngeal cancer. Early-stage supraglottic laryngeal cancer (SGLC) is prone to LNM. However, research on risk factors for predicting cervical LNM in early-stage SGLC is limited. This study seeks to create and validate a predictive model through the application of machine learning (ML) algorithms.

Methods

The training set and internal validation set data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Data from 78 early-stage SGLC patients were collected from Fujian Provincial Hospital for independent external validation. We identified four variables associated with cervical LNM and developed six ML models based on these variables to predict LNM in early-stage SGLC patients.

Results

In the two cohorts, 167 (47.44%) and 26 (33.33%) patients experienced LNM, respectively. Age, T stage, grade, and tumor size were identified as independent predictors of LNM. All six ML models performed well, and in both internal and independent external validations, the eXtreme Gradient Boosting (XGB) model outperformed the other models, with AUC values of 0.87 and 0.80, respectively. The decision curve analysis demonstrated that the ML models have excellent clinical applicability.

Conclusions

Our study indicates that combining ML algorithms with clinical data can effectively predict LNM in patients diagnosed with early-stage SGLC. This is the first study to apply ML models in predicting LNM in early-stage SGLC patients.

Nomogram for predicting early death in elderly patients with laryngeal squamous cell carcinoma: A population-based SEER study

BACKGROUND

The disease and mortality rates of patients with laryngeal squamous cell carcinoma (LSCC) stabilize after peaking at the age of 60 years. This study aimed to identify risk factors associated with early death (death within 6 months) in elderly (≥60 years) patients with LSCC and to establish predictive nomograms to aid clinicians in developing individualized treatment plans.

METHODS

Data pertaining to elderly patients with LSCC between 2004 and 2015 was obtained from the Surveillance, Epidemiology, and End Results database (version 8.4.0). Multiple logistic models were used to identify the independent risk factors associated with early mortality. The overall risk of early death was predicted using a web-based probability calculator and predictive nomogram. The cohort underwent decision curve analysis (DCA), calibration, and receiver operating characteristic curves to evaluate the clinical applicability and predictability of the models during the training and validation stages.

RESULTS

This study included 10,031 patients, of which 1,711 (17.0%) experienced all-cause early death, and 1,129 died from cancer-specific causes. Patients with LSCC who had overlapping laryngeal lesions, advanced age, unmarried status, high tumour and node stages, presence of distant metastases, and lack of treatment were at risk for early death. According to the nomograms, the risk of all-cause death and cancer-specific early death had an area under the curve of 0.796 and 0.790, respectively. Internal validation and DCA revealed that the prediction model was accurate and could be applied clinically.

CONCLUSION

The study provides an overview of the characteristics of early death in patients with LSCC. Among the prognostic factors, T stage and radiotherapy demonstrated the strongest predictive value for early mortality, while marital status and tumor grade had the worst prognostic value. Two nomogram plots were constructed to facilitate accurate prediction of all-cause and cancer-specific early mortality within 6 months in elderly patients with LSCC, thereby helping clinicians in providing more personalised treatment plans.

Treatment discordance in the utilization of neck dissection for stage I-II supraglottic tumors

BACKGROUND

In 2018, the National Comprehensive Cancer Network treatment guidelines began recommending the use of neck dissection during surgical management of stage I-II supraglottic laryngeal squamous cell carcinoma (LSCC).

METHODS

Trends and factors associated with the use of neck dissection during larynx-preserving surgery for patients with cT1-2, N0, M0 supraglottic LSCC in the National Cancer Database (2004-2020) were evaluated using multivariable-adjusted logistic regression.

RESULTS

Of the 2080 patients who satisfied study eligibility criteria, 633 (30.4%) underwent neck dissection. Between 2018 and 2020, the rate of neck dissection was 39.0% (114/292). After multivariable adjustment, academic facility type, undergoing biopsy prior to surgery, and more radical surgery were significant predictors of receiving neck dissection.

CONCLUSIONS

The results of this national analysis suggest that the utilization of guideline-concordant neck dissection for management of stage I-II supraglottic LSCC remains low and highlight the need to promote the practice of neck dissection for this patient population.

Outcomes of mini-invasive transoral surgery without neck dissection in supraglottic laryngeal cancer: Real world data from a tertiary cancer center

PURPOSE

The neck management in early-stage cN0 supraglottic cancer represents an argument of debate. The aim of our study is to evaluate the oncological and functional outcomes in patients with early-stage cN0 supraglottic carcinoma treated with a wait-and-see policy for the neck.

MATERIALS AND METHODS

Retrospective monocentric cohort study in a referral cancer care center. We collected a consecutive sample of patients from 2000 to 2020 with Squamous Cell Carcinoma of the supraglottis without clinical evidence of nodal metastases (cN0), surgically treated with Transoral Surgery (Laser or Robotic) without neck dissection. From 316 supraglottic cancer we finally selected 66 eligible participants that met all inclusion criteria.

RESULTS

Sixty-six patients (M 75.8 % vs F 24.2 %), median age 65.8 years (IQR 60.9, 70.5). The most common subsite was the epiglottis (62.1 %). Tumor stage distribution was as follows: 35 % cT1, 53 % cT2, 15.2 % cT3. Neither deaths nor major treatment-related complications were reported after surgery. The median follow-up was 62 months. For oncological outcomes, we evaluated 56 patients (10 excluded for adjuvant radiotherapy): 5-year overall survival rate 87 % (CI 95 %: 73.1-94), disease- specific survival rate 95.3 % (CI 95 %: 82-98.8) and neck recurrence-free survival rate 87 % (CI 95 %: 73.1-94). Six patients developed neck recurrence, with a median time of 13 months.

CONCLUSIONS

Supraglottic carcinoma has been historically associated to a considerable risk of occult metastasis. However, in early-stage cases data are still inconclusive. Our results suggest that in such patients a wait-and-see policy does not impact negatively on survival outcomes, while granting the reduced morbidity associated to a minimally invasive surgical approach.

Impact of Obstructive Sleep Apnea on Health-Related Quality of Life in Patients With Partial Laryngectomy for Laryngeal Cancer

Objectives: To evaluate the possible risk factors of obstructive sleep apnea (OSA) and its impact on the health-related quality of life (HRQoL) in patients with partial laryngectomy for laryngeal cancer. Methods: A cross-sectional method was used to carry out this study. Patients who underwent partial laryngectomy for laryngeal cancer completed overnight polygraphy (PG) home sleep tests and quality of life questionnaires. The Medical Outcome Study 36-item Short-Form Health Survey (SF-36) questionnaire was used to investigate the factors influencing HRQoL. Results: A total of 59 patients completed the PG tests and quality of life questionnaires, with 74.6% demonstrating evidence of OSA. There were significant differences in tumor area and neck dissection between OSA group and non-OSA groups. Based on sleep-related parameters, patients were divided into cluster 1 (n = 14) and cluster 2 (n = 45) using principal component analysis combined with K-means clustering. Two clusters had significantly different scores of body pain, general health, and health transition in SF-36 domains. Independent factors associated with general health were identified as tobacco use (OR = 4.716), alcohol use (OR = 3.193), and OSA-related condition (OR = 11.336). Conclusions: Larger tumor area and neck dissection might be associated with an increased risk for developing OSA in patients with partial laryngectomy for laryngeal cancer. OSA partially mediated the effect on physical health, including body pain, general health, and health transition. It is important to be aware of the potential impact of OSA on diminished HRQoL of these patients.