Management of the N0 neck in patients with laryngeal squamous cell carcinoma

Abstract

Background: Neck lymph node status is the chief prognostic index in patients with head and neck squamous cell carcinoma (SCC), yet the management of a clinically negative neck in this setting is still controversial, especially in patients with laryngeal SCC (LSCC).

Objectives: To evaluate the efficacy of selective neck dissection (SND) to control occult disease in patients with LSCC and clinically negative (cN0) necks.

Materials and methods: Medical records of 1476 patients with cN0 LSCC were analyzed. In conjunction with primary treatment, 126 (8.5%) underwent at least unilateral elective neck dissection, whereas most 1350 (91.5%) followed a wait-and-see protocol. Prognostic significance was indicated by the Kaplan–Meier survival estimates.

Results: The rate of occult neck disease was 15%. Five-year overall and disease-free survival rates were 74.4% and 66.7%, respectively. Prognosis was closely related to T stage, preoperative tracheotomy, and postoperative recurrence. There was no significant correlation with age, sex, or preoperative neck dissection; but in patients with supraglottic LSCC, the relation between prognosis and preoperative neck dissection was significant, with fewer neck and local recurrences than the wait-and-see group (p < .05).

Conclusions and significance: Selective neck dissection is serving as an accurate prognostic tool in patients with supraglottic laryngeal cancers.

背景：颈淋巴结状态是头颈鳞状细胞瘤（SCC）患者的主要预后指标；然而在这种情况下, 临床阴性颈的治疗仍有争议, 对喉癌（LSCC）患者尤为如此。

目的：评价选择性颈部解剖（SND）对LSCC及临床阴性（cN0）颈部隐性疾病的控制效果。

材料与方法：对1476例cN0型LSCC患者的病历进行分析。在一级治疗中, 126例（8.5%）至少接受了单侧选择性颈部解剖, 而大多数1350例（91.5%）遵循了“等等再说”的常规。Kaplan–Meier生存率评估显示其预后意义。

结果：隐性颈病发生率为15%。五年总生存率和无病生存率分别为74.4%和66.7%。预后与T期、术前气管切开术、术后复发密切相关。与年龄、性别或术前颈部解剖无显著相关性；但在声门上型LSCC患者中, 预后与术前颈部解剖具有显著相关性, 颈部和局部复发率低于“等等再说”组（P<0.05）。

结论与意义：选择性颈部解剖是声门上喉癌患者准确的预后工具。

Keywords:

• Selective neck dissection
• laryngeal squamous cell carcinoma
• prognosis

Disclosure statement

The authors declare there are no potential conflicts of interest.