In the current issue, Tsai et al1 have analyzed the National Cancer Database (NCDB) to investigate the impact of lymph node yield from elective neck dissection performed on patients with early stage oral cavity cancer. This topic is particularly relevant given recent data from a prospective randomized trial2 demonstrating that elective neck dissection in patients with early stage oral cavity cancer is associated with increased survival. The extent of the elective neck dissection that needs to be performed, and how to assess potential survival benefit from lymphadenectomy is a topic of active research, and several studies have proposed different thresholds for increased overall survival. In a retrospective study, Ebrahimi et al3 cited 18 lymph nodes as an adequate number for improved survival in patients with oral squamous cell carcinoma. More recently, Divi et al4,5 and Kuo et al6 have examined survival data from the prospective Radiation Therapy Oncology Group clinical trials and the NCDB and established a cut off of 18 and 16, respectively, for an adequate lymph node harvest associated with improved survival. Tsai et al1 suggest that 24 lymph nodes is the optimal number associated with increased survival. Several studies have demonstrated a survival benefit with higher lymph node harvests in oral cavity, head and neck cancer, and papillary thyroid cancer,4,6,7 and there is an emerging body of literature regarding surgical lymph node count and survival from multiple types of cancer. This has been perhaps best studied in colon cancer, where lymph node yield is an established quality metric and is included in National Comprehensive Cancer Network (NCCN) guidelines.8
Mallen-St. Clair J. Quality Metrics in Oral Cavity Cancer—Developing Standards for Optimal Lymph Node Yield. JAMA Otolaryngol Head Neck Surg. 2017;143(10):973–974. doi:10.1001/jamaoto.2017.0978
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