Lymph Nodes Dissection in Elderly Patients with T3-T4 Laryngeal Cancer

Figures & data

Table 1 The Clinical Characteristics of Elderly Patients T3-T4 Laryngeal Cancer Before and After Propensity Score Matching

Variable	Before PSM^a (n=969)			After PSM (n=433)
	N-LND^b (n= 147, 15.2%)	LND^c (n=822, 84.8%)	p-value	N-LND (n=118, 27.3%)	LND (n=315,72.7%)	p-value
Age at Diagnosis, Years			0.002			0.440
65–74	87(9.0%)	573(59.1%)		72(16.6%)	193(44.6%)
75–85	44(4.5%)	216(22.3%)		35(8.1%)	103(23.8%)
≥85	16(1.7%)	33(3.4%)		11(9.3%)	19(4.4%)
Race			0.708			0.873
Black	18 (1.9%)	118 (12.2%)		15 (3.5%)	253 (58.4%)
White	122 (12.6%)	654 (67.5%)		97 (22.4%)	41 (9.5%)
Other^d	7 (0.7%)	50 (5.2%)		6 (1.4%)	21 (4.8%)
Gender			0.091			1.000
Male	116 (12.0%)	695 (71.7%)		98 (22.6%)	262 (60.5%)
Female	31 (3.2%)	127 (13.1%)		20 (4.6%)	53 (12.2%)
Income, Thousand Dollars			0.725			0.863
≦50	36 (3.7%)	195 (20.1%)		28 (6.5%)	83 (19.2%)
50–75	77 (7.9%)	457 (47.2%)		62 (14.3%)	159 (36.7%)
≥75	34 (3.5%)	170 (17.5%)		28 (6.5%)	73 (16.9%)
Site			0.275			0.986
Glottis	65 (6.7%)	295 (30.4%)		48 (11.1%)	124 (28.6%)
Subglottis	7 (0.7%)	46 (4.7%)		7 (1.6%)	19 (4.4%)
Supraglottis	41 (4.2%)	280 (28.9%)		32 (7.4%)	83 (19.2%)
Other	34 (3.5%)	201 (20.7%)		31 (7.2%)	89 (20.6%)
Laterality			0.128			0.869
Right	17 (1.8%)	55 (5.7%)		96 (22.2%)	262 (60.5%)
Left	13 (1.3%)	75 (7.7%)		10 (2.3%)	23 (5.3%)
Unilateral, unknown	117 (12.1%)	681 (70.3%)		12 (2.8%)	30 (6.9%)
Bilateral	0 (0.0%)	11 (1.1%)		0 (0.0%)	0 (0.0%)
Histologic Type			0.690			0.610
SCC^e	138 (14.2%)	779 (80.4%)		112 (25.9%)	302 (69.7%)
Other	9 (0.9%)	43 (4.4%)		6 (1.4%)	13 (3.0%)
Tumor Size, cm			< 0.001			0.798
< 3	52 (5.4%)	233 (24.0%)		42 (9.7%)	110 (25.4%)
3–5	59 (6.1%)	450 (46.4%)		55 (12.7%)	158 (36.5%)
> 5	10 (1.0%)	95 (9.8%)		9 (2.1%)	23 (5.3%)
Unknown	26 (2.7%)	44 (4.5%)		12 (2.8%)	24 (5.5%)
Fuhrman Grade			0.009			0.929
Grade 1–2	94 (9.7%)	508 (52.4%)		74 (17.1%)	202 (46.7%)
Grade 3–4	41 (4.2%)	289 (29.8%)		38 (8.8%)	98 (22.6%)
Unknown	12 (1.2%)	25 (2.6%)		6 (1.4%)	15 (3.5%)
T Stage			0.004			0.445
T3	71 (7.3%)	287 (29.6%)		52 (12.0%)	126 (29.1%)
T4	76 (7.8%)	535 (55.2%)		66 (15.2%)	189 (43.6%)
N Stage			<0.001			0.411
N0	123 (12.7%)	410 (42.3%)		98 (22.6%)	271 (62.6%)
N1	9 (0.9%)	118 (12.2%)		7 (1.6%)	16 (3.7%)
N2	12 (1.2%)	277 (28.6%)		11 (2.5%)	27 (6.2%)
N3	0 (0.0%)	15 (1.5%)		0 (0.0%)	0 (0.0%)
Unknown	3 (0.3%)	2 (0.2%)		2 (0.5%)	1 (0.2%)
M Stage			0.240			1.000
M0	141 (14.6%)	807 (83.3%)		115 (26.6%)	308 (71.1%)
M1	6 (0.6%)	14 (1.4%)		3 (0.7%)	7 (1.6%)
Unknown	0 (0.0%)	1 (0.1%)		0 (0.0%)	0 (0.0%)
Primary Surgery			<0.001			0.083
Partial excision	44 (4.5%)	35 (3.6%)		18 (4.2%)	29 (6.7%)
Radical laryngectomy	103 (10.6%)	787 (81.2%)		100 (20.1%)	286 (66.1%)

Abbreviations: ^aPSM, propensity score matching; ^bN-LND, not lymph node dissection; ^cLND, lymph node dissection; ^dOther, American Indian/AK Native, Asian/Pacific Islander and other races; ^eSCC, squamous cell cancer.

Figure 1 Kaplan–Meier curves of OS and CSS according to whether or not LND has been done for patients with T3-T4 laryngeal cancer. (A and B) the OS of patients before and after PSM. (C and D) the CSS of patients before and after PSM.

Figure 2 Competing risk curve of CSS among elderly patients with T3-T4 laryngeal cancer: before PSM (A) and after PSM (B).

Figure 3 Kaplan–Meier curves of OS (A) and CSS (B) according to whether or not lymph node metastasis has.

Table 2 Multivariable Cox Regression of Risk Factors for Lymph Node Metastasis Among Patients Who Underwent Lymph Node Dissection

	Rate (N+ ^a/LND^b, %)	Univariate			Multivariate
		OR^c	95% CI^d	p-value	OR^c	95% CI^d	p-value
Age at Diagnosis, Years				0.352			0.809
65–74	295/571, 51.7%	1.283	(0.634, 2.595)	0.489	1.093	(0.500, 2.386)	0.824
75–85	100/216, 46.3%	1.034	(0.496, 2.159)	0.928	0.978	(0.435, 2.202)	0.958
≥85	15/33, 45.5%	-	-	Rf	-	-	Rf
Race				0.915			0.722
White	325/652, 49.8%	1.988	(0.179, 22.029)	0.576	4.363	(0.334, 57.040)	0.261
Black	59/118, 50.0%	2.000	(0.177, 22.659)	0.576	4.251	(0.317, 57.060)	0.275
Other^e	25/47, 53.2%	2.273	(0.193, 26.812)	0.514	4.670	(0.335, 65.061)	0.252
Unknown	1/3, 33.3%	-	-	Rf	-	-	Rf
Gender				0.923			0.429
Male	347/693, 50.1%	1.019	(0.698, 1.487)	0.923	1.184	(0.779, 1.802)	0.429
Female	63/127, 49.6%	-	-	Rf	-	-	Rf
Income, Thousand Dollars				0.121			0.707
≦50	106/194, 54.6%	1.057	(0.699, 1.599)	0.792	0.967	(0.607, 1.538)	0.886
50–75	214/457, 46.8%	0.773	(0.543, 1.101)	0.154	0.865	(0.587, 1.277)	0.466
≥75	90/169, 53.3%	-	-	Rf	-	-	Rf
Site				< 0.001			< 0.001
Glottis	110/295, 37.3%	-	-	Rf	-	-	Rf
Subglottis	12/46, 26.1%	0.594	(0.295, 1.194)	0.144	0.503	(0.239, 1.059)	0.070
Supraglottis	185/279, 66.3%	3.310	(2.350, 4.662)	< 0.001	2.995	(2.029, 4.422)	< 0.001
Other	103/200, 51.5%	1.786	(1.241, 2.570)	0.002	1.526	(1.032, 2.255)	0.034
Laterality				0.201			0.380
Unilateral	348/679, 51.3%	0.601	(0.174, 2.071)	0.420	0.426	(0.112, 1.619)	0.211
Left	30/75, 40.0%	0.381	(0.103, 1.415)	0.150	0.320	(0.077, 1.325)	0.116
Right	25/55, 45.5%	0.476	(0.125, 1.815)	0.277	0.350	(0.082, 1.492)	0.156
Bilateral	7/11, 63.6%	-	-	Rf	-	-	Rf
Histologic Type				0.004			0.099
SCC^f	379/777, 48.8%	0.369	(0.187, 0.728)	0.004	0.533	(0.252, 1.126)	0.099
Other	31/43, 72.1%	-	-	Rf	-	-	Rf
Tumor Size, cm				< 0.001			< 0.001
< 3	83/232, 35.8%	-	-	Rf	-	-	Rf
3–5	235/449, 52.3%	1.971	(1.423, 2.731)	< 0.001	1.683	(1.178, 2.403)	0.004
> 5	65/95, 68.4%	3.890	(2.338, 6.472)	< 0.001	3.010	(1.732, 5.232)	< 0.001
Unknown	27/44, 61.4%	2.851	(1.468, 5.536)	0.002	2.722	(1.344, 5.511)	0.005
Fuhrman Grade				<0.001			<0.001
Grade 1–2	213/506, 42.1%	-	-	Rf	-	-	Rf
Grade 3–4	182/289, 63.0%	2.340	(1.739, 3.149)	<0.001	2.101	(1.525, 2.893)	<0.001
Unknown	15/25, 60.0%	2.063	(0.909, 4.682)	0.083	1.809	(0.726, 4.510)	0.203
T Stage				0.558			0.408
T3	147/286, 51.4%	1.090	(0.818, 1.452)	0.558	0.867	(0.618, 1.216)	0.408
T4	263/534, 49.3%	-	-	Rf	-	-	Rf
M Stage				0.288			0.267
M0	401/806, 49.8%	0.550	(0.183, 1.656)	0.288	0.487	(0.137, 1.733)	0.267
M1	9/14, 64.3%	-	-	Rf	-	-	Rf

Abbreviations: ^aN+, positive lymph node; ^bLND, lymph node dissection; ^cOR, odds ratio; ^d95% CI, 95% confidence interval; ^eOther, American Indian/AK Native, Asian/Pacific Islander and other races; ^fSCC, squamous cell cancer.

Figure 4 The nomogram for the preoperative prediction of lymph node metastases (A). Calibration curves of the nomogram in the training set (B) and validation set (C). Plots (D and E) show the receiver–operator characteristic (AUC) curves of the nomogram in the training and validation sets, respectively.

Figure 5 Decision curve analysis for the prediction nomogram.