Patterns of cervical lymph node metastasis in supraglottic laryngeal cancer and therapeutic implications of surgical staging of the neck.

Autor: Kürten CHL; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany., Zioga E; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany., Gauler T; Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany., Stuschke M; Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany., Guberina M; Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany., Ludwig JM; Department of Radiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany., Deuss E; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany., Mattheis S; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany., Lang S; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany., Hussain T; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany. timon.hussain@uk-essen.de.
Jazyk: angličtina
Zdroj: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery [Eur Arch Otorhinolaryngol] 2021 Dec; Vol. 278 (12), pp. 5021-5027. Date of Electronic Publication: 2021 Mar 27.
DOI: 10.1007/s00405-021-06753-1
Abstrakt: Purpose: Accurate therapeutic management of the neck is a challenge in patients with supraglottic laryngeal cancer. Nodal metastasis is common at all disease stages, and treatment planning relies on clinical staging of the neck, for both surgical and non-surgical treatment. Here, we compared clinical and surgical staging results in supraglottic carcinoma patients treated with primary surgery to assess the accuracy of pre-therapeutic clinical staging and guide future treatment decisions.
Methods: Retrospective analysis of clinical, pathological, and oncologic outcome data of 70 patients treated with primary surgery and bilateral neck dissection for supraglottic laryngeal cancer. Patients where clinical and pathological neck staging results differed, were identified and analyzed in detail.
Results: On pathologic assessment, patients with early stage (pT1/2) primaries showed cervical lymph node metastases in 55% (n = 17/31) of cases, compared to 67% (n = 26/39) of patients with pT3/4 tumors. In 24% (n = 17/70) of all patients, cN status differed from pN status, resulting in an upstaging in 16% of cases (n = 11/70) and a downstaging in 9% (n = 6/70) of cases. 14% of patients with cN0 status had occult metastases (n = 5/30). As assessed by a retrospective tumor board, in case of a non-surgical treatment approach, the inaccurate clinical staging of the neck would have led to an over- or undertreatment of the neck in 20% (n = 14/70) of all patients.
Conclusion: Our data re-emphasize the high cervical metastasis rates of supraglottic laryngeal cancer across all stages. Inaccurate clinical staging of the neck is common and should be taken into consideration when planning treatment.
(© 2021. The Author(s).)
Databáze: MEDLINE
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