Objective: To examine the association between survival and the number of lymph nodes (LNs) examined among persons who underwent surgery for node-negative tongue cancer that was confirmed by pathologic findings. Methods: Data from the Surveillance Epidemiology and End Results (SEER) database were reviewed (1988-2002). The association between survival and the number of regional LNs evaluated during surgery among patients with tongue cancer was examined by constructing Kaplan-Meier curves. We also used multivariate Cox proportional hazard models to calculate age-, race-, sex-, grade-, and diagnosis year–adjusted hazard ratios (HRs) for different numbers of LNs. In these analyses, a hazard ratio of less than 1.0 indicates increased survival. Results: A total of 1064 patients were included in the study. The unadjusted (Kaplan-Meier) survival analyses demonstrated that in comparison to the reference group (1-10 LNs), patients who had at least 11 LNs examined during surgery had a statistically significant increase in survival rate (log rank, P = .01). This association persisted after adjustment for potential confounders (hazard ratio, 0.75; 95% confidence interval, 0.59-0.94). Similar analyses by LN tertile, using the lowest tertile (1-12 LNs) as reference, demonstrated that patients in the second tertile (13-25 LNs) had significantly improved survival (a hazard ratio, 0.68; 95% confidence interval, 0.52-0.89), but there seems to be no incremental improvement after evaluating more than 25 LNs (hazard ratio, 0.80; 95% confidence interval, 0.61-1.03). Conclusions: These data suggest that an optimal staging should be between 10 and 25 regional LNs. Accurate staging of cervical lymphatics dictates appropriate adjuvant treatment.
Archives of Otolaryngology - Head & Neck Surgery – American Medical Association
Published: Aug 1, 2006
Keywords: postoperative care,surgical procedures, operative,lymph nodes,surgery specialty,tongue cancer