Head and Neck Cancer

PV QA 2 - Poster Viewing Q&A 2

MO_26_2617 - Predictors of contralateral and bilateral lymph node metastases in head and neck cancer: A closer look at the ipsilateral neck

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Predictors of contralateral and bilateral lymph node metastases in head and neck cancer: A closer look at the ipsilateral neck
B. Jones1, T. Li2, J. A. Ridge2, M. Lango2, C. Fundakowski2, J. Liu2, and T. J. Galloway2; 1Geisinger Commonwealth School of Medicine, Scranton, PA, 2Fox Chase Cancer Center, Philadelphia, PA

Purpose/Objective(s): The decision to perform an elective contralateral neck dissection in a clinically node negative hemi-neck is determined by the proximity of the primary squamous cell carcinoma (SCCA) to midline. This analysis attempts to identify additional predictors of pathologically confirmed contralateral neck nodes.

Materials/Methods: We performed a retrospective analysis of previously untreated patients treated with primary surgery and bilateral neck dissections at a single institution (2007 to 2017). The indications for contralateral neck dissection at our institution are primary site disease within 1-2 cm of midline and/or clinical contralateral disease at diagnosis. Predictive factors at both the primary site (tumor site (oral cavity v pharynx/larynx), T stage (T4 v T1-3), grade, PNI, LVSI) and in the ipsilateral neck (N stage (N0-1 v N2-3), ECS) were examined in a univariate analysis using Fischer’s exact. Two multivariate analyses using logistic regression was performed to evaluate variables associated with pN2c disease: one in which cN2c patients (n=9) were excluded and a second that exclusively evaluated primary site variables in which no patients were excluded. We also compared weighted kappa coefficients to evaluate concordance between clinical and pathologic contralateral nodal staging with and without a pre-operative PET scan.

Results: We identified 64 patients treated with bilateral neck dissection with median follow up of 23.9 months (range, 4.3-122.8), 38 (59%) of which were clinically node negative (cN0) and 16 (25%) were cT4. The primary tumor sites were alveolus (27%, n=19), tongue (28%, n=18), FOM (16%, n=10), larynx (25%, n=12), tonsil (2%, n=1). The overall rate of pN2c necks was 23% (15/64), with only 3% (1/38) of these patients presenting with cN0. On univariate analysis there was a correlation between clinical nodal stage (p<0.001), LVSI (p=0.04), ECS (p<0.001) and contralateral lymph node metastases in patients with clinically negative contralateral necks. On multivariate analysis excluding patients with cN2c necks the only significant independent predictor of contralateral metastases was a clinical N2b neck (OR 16.8, 95% CI 1.1-242.9, p=0.04).No primary site variables were significant. In the analysis limited to the primary site no variables significantly predicted bilateral neck disease, although LVSI approached significance (p=0.09). PET-CT and anatomic imaging scans were performed on 42% (n=27) and 94% (n=60) of our cohort at a median of 22 days and 29 days prior to the operation, respectively. Concordance between clinical and pathologic nodal staging was not adjusted by performance of a PET scan (p=0.72).

Conclusion: Among patients with primary tumor within 1-2 cm of midline, advanced ipsilateral neck disease is a significant predictor of occult contralateral metastases. Contralateral neck disease is rare in the cN0 patient.

Author Disclosure: B. Jones: None. T. Li: None. J.A. Ridge: None. C. Fundakowski: None. J. Liu: None. T.J. Galloway: Speaker's Bureau; Varian. Co-Chair; Rare Tumors Task Force.

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