Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Program Number: B328
Session Name: Poster Session
Lymph node yield is not associated with survival in total laryngectomy patients
Whitney Jin, BA1; Daniel R Habib, BA2; Clara D Si, BA2; Brooke B Swain, BS2; Sindhura Sridar, BS1; Robert Sinard, MD1; Michael C Topf, MD1; 1Vanderbilt University Medical Center; 2Vanderbilt University School of MedicineObjectives: Lymph node yield (LNY) has been proposed as a potential quality metric in head and neck cancer care. Several studies have demonstrated that a neck dissection with fewer than 18 lymph nodes removed and counted is associated with inferior survival outcomes in oral cavity and oropharynx cancer. The objective of this study is to determine the impact of LNY on overall survival (OS), disease free survival (DFS), and regional recurrence free survival (RRFS) in patients undergoing total laryngectomy and neck dissection.
Study design: Single-institution retrospective analysis.
Methods: Total laryngectomy patients from 1999-2024 were stratified based on LNY greater or less than 18. Analyses included Kaplan-Meier survival analysis and cox proportional hazard analysis. Covariates included age, pathologic T and N stage, lymphovascular invasion, perineural invasion, extranodal extension, prior radiation, adjuvant radiation, and adjuvant chemotherapy. LNY for bilateral neck dissection was divided by two as previously reported. Independent t-tests were used to compare LNY by preoperative radiation status.
Results: The total cohort included 709 total laryngectomy and neck dissection patients. Mean LNY was 22.1 (SD=16.2). LNY was greater than or equal to 18 for 404 (41.3%) patients. Mean LNY was 28.5 (SD=13.7) for primary TL patients versus 18.5 (SD=16.4) for salvage TL patients (p<.001). On Kaplan-Meier survival analysis, there was a non-significant trend for LNY≥18 being associated with improved OS (p=.107) (Fig. 1), DFS (p=.057) (Fig. 2), and RRFS (p=.160) (Fig. 3). After controlling for covariates, there was a non-significant trend of LNY≥18 being independently associated with improved OS (HR=0.80, 95% CI: 0.56-1.16, p=.240), DFS (HR=0.78, 95% CI: 0.57-1.07, p=.126), and RRFS (HR=0.79, 95% CI: 0.53-1.17, p=.357). Prior radiation was not associated with OS (HR=0.89, 95% CI: 0.57-1.40, p=.620) or RRFS (HR=1.27, 95% CI: 0.82-1.96, p=.280) but was associated with DFS (HR=1.62, 95% CI: 1.06-2.46, p=.024).
Conclusion: In this large single-institution cohort of patients who underwent total laryngectomy and neck dissection, LNY≥18 was not independently associated with improved oncologic outcomes.
