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Tumor cell viability in salvage neck dissections: Poor prognosis predicted by high postradiation nodal SUV max , p16‐negativity, and low nodal shrinkage


Rüegg, Pascal; Morand, Grégoire B; Kudura, Ken; Rupp, Niels J; Hüllner, Martin W; Broglie, Martina A (2020). Tumor cell viability in salvage neck dissections: Poor prognosis predicted by high postradiation nodal SUV max , p16‐negativity, and low nodal shrinkage. Head and Neck, 42(4):660-669.

Abstract

Background

After primary chemoradiation in advanced oropharyngeal, laryngeal, and/or hypopharyngeal cancer, nodal disease may require a salvage neck dissection. However, salvage neck dissection is associated with increased morbidity and may only be necessary in case of persistence of viable tumor cells, which can be difficult to confirm and virtually impossible to exclude by fine needle aspiration cytology. We, therefore, aimed to identify predictive factors for the persistence of viable tumor cells in lymph node metastases from head and neck squamous cell cancer after chemoradiation.
Methods

We performed a retrospective review of neck dissection specimens performed after primary (chemo‐)radiation for oropharyngeal, laryngeal, or hypopharyngeal squamous cell carcinoma. All patients were treated at University Hospital Zurich from 2007 to 2016.
Results

A total of 78 patients were included. Thirty‐eight patients (48.7%) had viable tumor cells in their neck dissection sample. High postradiation nodal maximum standardized uptake value (SUVmax), p16 negativity, and low nodal shrinkage were predictors of viable tumor cells in salvage neck dissections (Mann‐Whitney U/chi‐squared test, P < .001, P = .025, and P = .042, respectively). Patients with viable tumor cells showed a significantly worse locoregional recurrence‐free survival, distant metastasis‐free survival, and disease‐specific survival (log‐rank test, P < .001).
Conclusions

Viable tumor cells can be predicted by high residual metabolic activity in the lymph nodes, negative p16 status, and low nodal shrinkage. Viable tumor cells in neck dissection specimens are associated with a poor survival and provide important prognostic information.

Abstract

Background

After primary chemoradiation in advanced oropharyngeal, laryngeal, and/or hypopharyngeal cancer, nodal disease may require a salvage neck dissection. However, salvage neck dissection is associated with increased morbidity and may only be necessary in case of persistence of viable tumor cells, which can be difficult to confirm and virtually impossible to exclude by fine needle aspiration cytology. We, therefore, aimed to identify predictive factors for the persistence of viable tumor cells in lymph node metastases from head and neck squamous cell cancer after chemoradiation.
Methods

We performed a retrospective review of neck dissection specimens performed after primary (chemo‐)radiation for oropharyngeal, laryngeal, or hypopharyngeal squamous cell carcinoma. All patients were treated at University Hospital Zurich from 2007 to 2016.
Results

A total of 78 patients were included. Thirty‐eight patients (48.7%) had viable tumor cells in their neck dissection sample. High postradiation nodal maximum standardized uptake value (SUVmax), p16 negativity, and low nodal shrinkage were predictors of viable tumor cells in salvage neck dissections (Mann‐Whitney U/chi‐squared test, P < .001, P = .025, and P = .042, respectively). Patients with viable tumor cells showed a significantly worse locoregional recurrence‐free survival, distant metastasis‐free survival, and disease‐specific survival (log‐rank test, P < .001).
Conclusions

Viable tumor cells can be predicted by high residual metabolic activity in the lymph nodes, negative p16 status, and low nodal shrinkage. Viable tumor cells in neck dissection specimens are associated with a poor survival and provide important prognostic information.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Otorhinolaryngology
04 Faculty of Medicine > University Hospital Zurich > Institute of Pathology and Molecular Pathology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Otorhinolaryngology
Uncontrolled Keywords:Otorhinolaryngology
Language:English
Date:1 April 2020
Deposited On:16 Jan 2020 10:12
Last Modified:29 Jul 2020 12:44
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1043-3074
OA Status:Closed
Publisher DOI:https://doi.org/10.1002/hed.26045
PubMed ID:31854495

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