Metabolic tumor volume of metastatic lymph nodes and survival after total laryngectomy in laryngeal and hypopharyngeal cancer. (June 2019)

• Record Type: Journal Article
• Authors: Fujii, T.; Miyabe, J.; Yoshii, T.; Suzuki, M.; Otozai, S.; Komukai, S.; Kishikawa, T.; Takemoto, N.; Fukusumi, T.; Tatsumi, M.; Hatazawa, J.; Inohara, H.
• Is Part Of: Oral oncology. Volume 93(2019)
• Page Start: 107
• Page End: 113
• Publication Date: 2019-06
• Subjects: Head and neck cancer -- Laryngeal cancer -- Hypopharyngeal cancer -- Total laryngectomy -- Metabolic tumor volume -- Extranodal extension; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2019.04.011
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Metabolic tumor volume of metastatic node (N-MTV) was prognostic in laryngectomy. We made recursive partitioning analysis (RPA) using N-MTV for risk stratification. The RPA model showed better concordance with survival than conventional grouping. A staging system incorporating N-MTV may better inform adjuvant treatment decisions. Abstract: Objectives: The prognostic value of metabolic tumor volume (MTV) in locally advanced laryngeal or hypopharyngeal cancer is established in the setting of chemoradiotherapy, while it remains unknown in the setting of upfront total laryngectomy. Materials and methods: We retrospectively analyzed 88 patients receiving total laryngectomy and neck dissection, using Cox regression models. Results and conclusion: Variables related to metastatic lymph node were associated with overall survival, whereas those related to primary tumor were not. In multivariable models, MTV of metastatic lymph nodes (N-MTV) as a continuous variable (Akaike's information criterion (AIC), 277.5) was equivalent to pathological nodal status (AIC, 278.2; P = 0.40), and superior to pathological nodal classification as an ordinal variable (AIC, 281.4; P < 0.05) in ability of predicting death. The risk of death was increased by 1.2-fold (95% confidence interval (CI), 1.0–1.4; P = 0.03) every 10-ml increment of N-MTV, while patients with pN+ disease were at a higher risk of death by 2.9-fold (95% CI, 1.0–12.2; P < 0.05) compared with patients with pN0 disease. Using recursive partitioning analysis (RPA), we classified the patients as having a low, intermediate, or high risk of death on the basis of N-MTV and extranodal extension (ENE). This RPA classification system exhibited greater concordance with overall survival than the classification considering pathological nodal status and ENE (AIC, 275.8 versus 281.4; P = 0.02). In the setting of upfront total laryngectomy, N-MTV is a critical predictor of mortality. A staging system in which N-MTV is incorporated may better inform adjuvant treatment decisions.