Among patients with head and neck cancer who have undergone neck dissection and are clinically node negative or node positive, those with at least 18 lymph nodes may have a significant advantage in overall survival, suggesting that lymph node count is a potential quality metric for neck dissection, according to a study published in the Journal of Clinical Oncology.1

Researchers in California identified patients who had undergone upfront nodal dissection for mucosal head and neck squamous cell carcinoma between 2004 and 2013 through the National Cancer Database. They examined 45,113 patients with at least 18 lymph nodes and 18,865 patients with less than 18 lymph nodes, stratifying these 2 groups on the basis of prior work.

A multivariable Cox proportional hazards regression model was constructed to predict hazard of mortality, and stratified models predicted hazard of mortality for patients who were both node-negative and node-positive.

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Risk-adjusted Cox models predicting hazard of mortality by lymph node count showed an 18% increased hazard of death for those patients with less than 18 lymph nodes. There was also an increased hazard of death for both groups when stratifying by clinical nodal stage.

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Patients with fewer than 18 lymph nodes had more favorable tumor characteristics, a lower proportion of T3 and T4 lesions, and lower rates of extracapsular extension, compared to those with at least 18 lymph nodes.


  1. Divi V, Chen MM, Nussenbaum B, et al. Lymph Node Count From Neck Dissection Predicts Mortality in Head and Neck Cancer. J Clin Oncol. 2016 Aug 1. doi: 10.1200/JCO.2016.67.3863 [Epub ahead of print]