Prognostic Value of Extranodal Extension in Head and Neck Cancers After Salvage Neck Dissection

Monday, September 30, 2024

1:42 PM – 1:48 PM EDT

Location: MBCC, 208

Disclosure(s):

Christopher Yam, MS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Sophie P. Gerndt, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Garren MI Low, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Warren C. Swegal, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Positive extranodal extension (ENE) is shown to be a strong prognostic factor for head and neck cancers in the primary setting. However, there are no studies in the salvage setting. Therefore, this study aims to determine the prognostic factor of ENE status in the salvage setting on survival outcomes.

Methods: A retrospective chart review of head and neck cancer patients who completed definitive radiation therapy +/- chemotherapy and subsequently underwent salvage neck dissection (ND) between 2017-2023 within a single institution. Groups were divided by ENE positive (+) or negative (-) status after salvage ND. Kaplan-Meier curves were used for overall survival (OS) and disease-free survival (DFS). Mann-Whitney U test and fishers-exact test were used.

Results: A total of 25 patients (male, n = 20, 80%) were included, all diagnosed with squamous cell carcinoma. Of these, 19 (76%) were ENE(-), and 6 (24%) were ENE(+). The most common site of primary tumor were oropharynx (n = 10, 40%) and larynx (n = 10, 40%), oral cavity (n = 2, 8%), unknown primary (n = 2, 8%) and cutaneous (n = 1, 4%). At the time of salvage ND, 6 patients had locoregional recurrence, 9 local only, 8 regional only and 2 were new primaries. All local only recurrences were ENE(-) subjects. The majority had a unilateral salvage ND (n = 17, 68%). ENE(+) group had a significantly greater average number of involved lymph nodes (3.0 ± 2.1) than the ENE(-) group (0.5 ± 1.3, p = 0.001). The ENE(+) group had a greater percentage of the following compared to the ENE(-) group: positive margins (50% vs. 42.1%), perineural invasion (PNI) (50% vs. 42.1%), and lymphovascular invasion (LVI) (66.7% vs. 26.3%). Both OS and DFS were statistically non-significant. ENE(+) group had a lower median month of OS (10 months) compared to ENE(-) (22 months).

Conclusions: The ENE(+) group had a lower median month of OS, a significantly higher average number of involved lymph nodes, and greater percentages of positive margins, PNI, and LVI than the ENE(-) group. Trends in this study suggest that ENE status in the salvage setting is a promising prognostic factor of survival outcomes despite limitations in sample size.

Presenting Author(s)

Christopher Yam, MS

Medical Student
Drexel University, College of Medicine
Herndon, VA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

SG

Sophie P. Gerndt, MD

Resident
Allegheny Health Network
Pittsburgh, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Garren MI Low, MD

Assistant Professor
Drexel UCOM / Allegheny Health Network
Pittsburgh , PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

Warren C. Swegal, MD

Assistant Professor - Dept of Otolaryngology Drexel University College of Medicine
Allegheny Health Network
Pittsburgh, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.