Prognostic capacity of the weighted lymph node ratio in head and neck squamous cell carcinoma patients treated with salvage neck dissection.

PURPOSE: The aim of the study was to assess the prognostic capacity of the recently described weighted lymph node ratio (WLNR) in patients with head and neck squamous cell carcinoma (HNSCC) who undergo salvage neck dissection for regional recurrence. MATERIAL AND METHODS: We retrospectively studied 197 adult patients with head and neck squamous cell carcinoma treated with salvage neck dissection from 1990 to 2017. RESULTS: The mean value for the WLNR for all patients was 26.2%. We established a classification based on the WLNR values taking 10.8% as the cut-off point. Five-year disease-specific survival for patients with WLNR ≤ 10.8% (n = 89, 45.2%) was 39.9% (IC 95% 29.4-50.4%), and for patients with WLNR ≥ 10.8% (n = 108, 54.8%) it was 20.5% (IC 95% 12.3-28.7%) (p = 0.007). The multivariate analysis showed the WLNR had a significant prognostic capacity. CONCLUSIONS: As a variable that integrates data related to the number of metastatic nodes with extracapsular spread to the LNR, the WLNR has a prognostic value in the pathological assessment of HNSCC patients with regional recurrence treated with salvage neck dissection.

Capacidad pronóstica de la densidad ganglionar en los carcinomas escamosos de cabeza y cuello / Prognostic capacity of the lymph node ratio in squamous cell carcinomas of the head and neck

INTRODUCCIÓN Y OBJETIVOS: La densidad ganglionar o lymph node ratio (LNR), definida como el cociente entre el número total de ganglios positivos y el número total de ganglios disecados, ha demostrado una capacidad pronóstica en diferentes modelos tumorales, incluidos los pacientes con carcinomas escamosos de cabeza y cuello (CECC). El objetivo del presente estudio es analizar el valor pronóstico de la LNR en una serie amplia de pacientes con CECC. MÉTODOS: Se llevó a cabo un estudio retrospectivo de una cohorte de 1.311 pacientes con CECC tratados con vaciamientos cervicales uni o bilaterales. El 55,0% de los pacientes incluidos en el estudio contaron con la presencia de metástasis a nivel ganglionar (pN + ). Se procedió a calcular el valor de la LNR y su categorización mediante un análisis de partición recursiva considerando la supervivencia específica como la variable dependiente. RESULTADOS: Se definieron 3 categorías en función del valor de la LNR con unos puntos de corte en los valores de 0,025 y 0,118. La supervivencia específica a los 5 años para los pacientes con una LNR inferior a 0,025 (n = 654, 49,8%) fue del 87,2%, para los pacientes con LNR 0,025-0,118 (n = 394, 30,1%) del 51,6% y para los pacientes con LNR superior a 0,188 (n = 263, 20,1%) del 27,3% (p = 0,0001). De acuerdo con los resultados de un análisis multivariante, la LNR se relacionó de forma significativa con la supervivencia específica. CONCLUSIÓN: La LNR puede ser una variable pronóstica a considerar en la estadificación patológica de las áreas ganglionares

INTRODUCTION AND OBJECTIVES: Lymph node density or lymph node ratio (LNR), defined as the quotient between the total number of positive lymph nodes and the total number of dissected lymph nodes, has demonstrated a prognostic capacity in several tumour models, including patients with head and neck squamous cell carcinomas (HNSCC). The aim of the present study is to analyse the prognostic value of LNR in a wide cohort of patients with HNSCC. METHODS: We carried out a retrospective study of a cohort of 1,311 patients with HNSCC treated with unilateral or bilateral neck dissections. Of the patients included in the study, 55.0% had lymph node metastases (pN + ). We proceeded to calculate the value of the LNR, and its categorization through a recursive partition analysis considering specific survival as the dependent variable. RESULTS: Three categories were defined according to the value of the LNR with a cut-off point at the values < of .025 and .118. The 5-year specific survival for patients with an LNR less than .025 (n = 654, 49.8%) was 87.2%, for patients with a LNR .025-.118 (n = 394, 30.1%) it was 51.6%, and for patients with a LNR greater than .188 (n = 263, 20.1%) it was 27.3% (P = .0001). According to the results of a multivariate analysis, the LNR significantly related to specific survival. CONCLUSION: The LNR can be a prognostic variable to be considered in the pathological staging of the lymph nodes

Valoración de la capacidad pronóstica de la afectación ganglionar de los pacientes con carcinoma de orofaringe en función del estatus HPV / Prognostic value of nodal involvement in patients with oropharyngeal carcinoma according to the HPV status

ANTECEDENTES Y OBJETIVO: Diferentes estudios realizados en poblaciones con una elevada incidencia de infección por HPV han encontrado una ausencia de capacidad pronóstica de la afectación ganglionar clínica (cN+) en los pacientes con carcinomas de orofaringe HPV-positivos. El objetivo del presente estudio fue evaluar la capacidad pronóstica de la afectación ganglionar en pacientes con carcinomas de orofaringe en función del estatus HPV en una población oncológica con una baja incidencia de infección por HPV. MATERIAL Y MÉTODOS: Estudio retrospectivo de una cohorte de 420 pacientes con carcinomas de orofaringe tratados durante el periodo 1990-2016 de los cuales se dispuso de información del estatus HPV. RESULTADOS: Un 14,8% de los pacientes incluidos en el estudio presentaron tumores HPV-positivos. En relación con los pacientes sin afectación ganglionar (cN0), la afectación ganglionar en el momento del diagnóstico (cN+) disminuyó de forma significativa la supervivencia específica de los pacientes con carcinomas de orofaringe HPV-negativos. Por el contrario, no aparecieron diferencias en la supervivencia para los pacientes con tumores HPV-positivos en función de la presencia de afectación ganglionar. El antecedente de consumo de tóxicos no modificó la ausencia de significado pronóstico de la afectación ganglionar para los pacientes con tumores HPV-positivos. CONCLUSIONES: La afectación regional en el momento del diagnóstico no es una variable con capacidad pronóstica para los pacientes con carcinomas de orofaringe HPV-positivos

BACKGROUND AND OBJECTIVE: Different studies performed in populations with a high incidence of HPV infection have found no prognostic capacity of clinical nodal involvement (cN+) in patients with HPV-positive oropharyngeal carcinomas. The objective of this study was to assess the prognostic ability of nodal involvement in patients with oropharyngeal carcinomas according to HPV status in a cancer population with a low incidence of HPV infection. MATERIAL AND METHODS: Retrospective study of a cohort of 420 patients with oropharyngeal carcinomas treated during the period 1990-2016 for whom information on HPV status was available. RESULTS: 14.8% of the patients included in the study had HPV-positive tumours. In relation to patients without nodal involvement (cN0), nodal involvement at diagnosis (cN+) significantly decreased the specific survival of patients with HPV-negative oropharyngeal carcinomas. Conversely, no differences in survival were found for patients with HPV-positive tumours according to the presence of nodal involvement. A history of toxic consumption did not change the absence of prognostic significance of nodal involvement for patients with HPV-positive tumours. CONCLUSIONS: Regional involvement at the time of diagnosis is not a prognostic variable for patients with HPV-positive oropharyngeal carcinomas

Prognostic capacity of the lymph node ratio in squamous cell carcinomas of the head and neck. / Capacidad pronóstica de la densidad ganglionar en los carcinomas escamosos de cabeza y cuello.

INTRODUCTION AND OBJECTIVES: Lymph node density or lymph node ratio (LNR), defined as the quotient between the total number of positive lymph nodes and the total number of dissected lymph nodes, has demonstrated a prognostic capacity in several tumour models, including patients with head and neck squamous cell carcinomas (HNSCC). The aim of the present study is to analyse the prognostic value of LNR in a wide cohort of patients with HNSCC. METHODS: We carried out a retrospective study of a cohort of 1,311 patients with HNSCC treated with unilateral or bilateral neck dissections. Of the patients included in the study, 55.0% had lymph node metastases (pN+). We proceeded to calculate the value of the LNR, and its categorization through a recursive partition analysis considering specific survival as the dependent variable. RESULTS: Three categories were defined according to the value of the LNR with a cut-off point at the values < of .025 and .118. The 5-year specific survival for patients with an LNR less than .025 (n=654, 49.8%) was 87.2%, for patients with a LNR .025-.118 (n=394, 30.1%) it was 51.6%, and for patients with a LNR greater than .188 (n=263, 20.1%) it was 27.3% (P=.0001). According to the results of a multivariate analysis, the LNR significantly related to specific survival. CONCLUSION: The LNR can be a prognostic variable to be considered in the pathological staging of the lymph nodes.

Weighted lymph node ratio: New tool in the assessment of postoperative staging of the neck dissection in HPV-negative head and neck squamous cell carcinoma patients.

BACKGOUND: The objective of this study is to assess a new parameter, the weighted lymph node ratio (WLNR), which incorporates prognostic information regarding the number of metastatic nodes with extracapsular spread and the lymph node yield for pN0 patients to the lymph node ratio. METHODS: We studied retrospectively 1118 patients with head and neck squamous cell carcinoma (HNSCC) treated with a neck dissection. RESULTS: We obtained a classification with four categories based on the WLNR values. WLNR classification had a higher prognostic discrimination capacity and a more homogeneous distribution in the number of patients included in each of the categories than the pTNM classification. CONCLUSION: The WLNR improved the predictive capacity of the eighth edition of the pTNM classification and it can be a useful tool in the assessment of the postoperative staging of the neck dissections in HNSCC patients.

Riesgo de aparición de segundas neoplasias y neoplasias sucesivas en pacientes con un tumor índice de cabeza y cuello / Risk of onset of second neoplasms and successive neoplasms in patients with a head and neck index tumour

OBJETIVO: Analizar la incidencia de aparición de segundas neoplasias y neoplasias sucesivas en una cohorte de pacientes con un carcinoma escamoso de cabeza y cuello. MATERIAL Y MÉTODOS: Estudio retrospectivo realizado en 4.458 pacientes con un tumor índice localizado en cabeza y cuello diagnosticados durante el periodo 1985-2016. Se llevó a cabo una evaluación de la incidencia de aparición de segundas neoplasias y neoplasias sucesivas a lo largo de un periodo de 30 años. RESULTADOS: Durante el seguimiento, un total de 1.203 pacientes (27,0%) contaron con la aparición de una segunda neoplasia, 242 (5,4%) con una tercera neoplasia, 58 (1,3%) con una cuarta y 8 (0,2%) con 5 o más neoplasias. La incidencia de aparición de segundas neoplasias fue del 3,5% anual, manteniéndose prácticamente constante a lo largo del periodo de seguimiento. Los pacientes que experimentaron la aparición de una segunda neoplasia contaron con un riesgo aumentado de presentar una tercera neoplasia, y los pacientes con una tercera neoplasia, con un riesgo aumentado de presentar una cuarta. Un 78% de las segundas, un 88% de las terceras y un 89,6% de las cuartas neoplasias aparecieron en localizaciones epidemiológicamente relacionadas con los consumos de tabaco y alcohol. CONCLUSIONES: Tras el diagnóstico y tratamiento de un tumor índice de cabeza y cuello los pacientes cuentan con un riesgo de aparición de una segunda neoplasia del 3,5% anual, y este riesgo permanece constante a lo largo del periodo de seguimiento a largo plazo

OBJECTIVE: To analyse the incidence of appearance of second and successive neoplasms in a cohort of head and neck squamous carcinoma patients. MATERIAL AND METHODS: We conducted a retrospective study with 4,458 patients with an index tumour located in the head and neck diagnosed during the 1985-2016 period. We evaluated the incidence of appearance of second neoplasms and successive neoplasms over a period of 30 years. RESULTS: During the follow-up, 1,203 patients (27.0%) had a second neoplasm, 242 patients (5.4%) a third neoplasm, 58 patients (1.3%) a fourth neoplasm, and 8 patients (0.2%) 5 or more successive neoplasms. The incidence of appearance of second neoplasms was 3.5% per year, remaining relatively constant throughout the follow-up period. The patients with a second neoplasm had a higher risk of appearance of a third neoplasm, and those with a third neoplasm had a higher risk of a fourth. Seventy-eight percent of the second neoplasms, 88% of the third neoplasms, and 89.6% of the fourth neoplasms appeared in locations epidemiologically related to tobacco and alcohol use. CONCLUSIONS: Second neoplasms after a head and neck index tumour appeared at a constant rate of 3.5% per year throughout the entire follow-up period

Prognostic value of nodal involvement in patients with oropharyngeal carcinoma according to the HPV status. / Valoración de la capacidad pronóstica de la afectación ganglionar de los pacientes con carcinoma de orofaringe en función del estatus HPV.

BACKGROUND AND OBJECTIVE: Different studies performed in populations with a high incidence of HPV infection have found no prognostic capacity of clinical nodal involvement (cN+) in patients with HPV-positive oropharyngeal carcinomas. The objective of this study was to assess the prognostic ability of nodal involvement in patients with oropharyngeal carcinomas according to HPV status in a cancer population with a low incidence of HPV infection. MATERIAL AND METHODS: Retrospective study of a cohort of 420 patients with oropharyngeal carcinomas treated during the period 1990-2016 for whom information on HPV status was available. RESULTS: 14.8% of the patients included in the study had HPV-positive tumours. In relation to patients without nodal involvement (cN0), nodal involvement at diagnosis (cN+) significantly decreased the specific survival of patients with HPV-negative oropharyngeal carcinomas. Conversely, no differences in survival were found for patients with HPV-positive tumours according to the presence of nodal involvement. A history of toxic consumption did not change the absence of prognostic significance of nodal involvement for patients with HPV-positive tumours. CONCLUSIONS: Regional involvement at the time of diagnosis is not a prognostic variable for patients with HPV-positive oropharyngeal carcinomas.

Risk of onset of second neoplasms and successive neoplasms in patients with a head and neck index tumour. / Riesgo de aparición de segundas neoplasias y neoplasias sucesivas en pacientes con un tumor índice de cabeza y cuello.

OBJECTIVE: To analyse the incidence of appearance of second and successive neoplasms in a cohort of head and neck squamous carcinoma patients. MATERIAL AND METHODS: We conducted a retrospective study with 4,458 patients with an index tumour located in the head and neck diagnosed during the 1985-2016 period. We evaluated the incidence of appearance of second neoplasms and successive neoplasms over a period of 30 years. RESULTS: During the follow-up, 1,203 patients (27.0%) had a second neoplasm, 242 patients (5.4%) a third neoplasm, 58 patients (1.3%) a fourth neoplasm, and 8 patients (0.2%) 5 or more successive neoplasms. The incidence of appearance of second neoplasms was 3.5% per year, remaining relatively constant throughout the follow-up period. The patients with a second neoplasm had a higher risk of appearance of a third neoplasm, and those with a third neoplasm had a higher risk of a fourth. Seventy-eight percent of the second neoplasms, 88% of the third neoplasms, and 89.6% of the fourth neoplasms appeared in locations epidemiologically related to tobacco and alcohol use. CONCLUSIONS: Second neoplasms after a head and neck index tumour appeared at a constant rate of 3.5% per year throughout the entire follow-up period.