Can the lymph node reactivity pattern in the pN0 neck analysis provide any additional prognostic information in patients with laryngeal squamous cell carcinoma?

• Main Authors: Gabriel Manfro, Claudio Cernea, Paulo Antônio Silvestre de Faria, Fernando Vaz Agarez, Fernando Luiz Dias, Roberto Araújo Lima, Lenine Garcia Brandão
• Format: Article
• Language: English
• Published: Instituto Israelita de Ensino e Pesquisa Albert Einstein 2010-03-01
• Series: Einstein (São Paulo)
• Subjects: Head and neck neoplasm; Carcinoma; squamous cell; Laryngeal neoplasm/immunology; Lymph node excision; Lymph node excision/adverse effects; Lymph node excision/mortality; Neoplasm recurrence; local; Neck dissection
• Online Access: http://apps.einstein.br/revista/arquivos/PDF/1429-Einsteinv8n1p68-74.pdf

Objective: To evaluate the influence of lymph node reactivity on recurrence and survival rates in a population of pT3 or pT4 pN0 patients with laryngeal squamous cell carcinoma. Methods: Between 2002 and 2005, 105 patients with LSSC underwent total laryngectomy with bilateral selective neck dissection including levels II, III and IV. Most (69) received PO radiotherapy. All pathological specimens were either pT3 or pT4, and all necks were pN0. All lymph nodes were analyzed and their reactivity status were classified as the following four patterns: follicular hyperplasia associated with humoral response, paracortical hyperplasia associated with cellular response, sinus histiocytosis with no association with specific immune response, or normal lymph node. Only the first two patterns were considered stimulated, whereas the last two were considered non-stimulated. The most prevalent pattern in a particular neck specimen was considered for the analysis of recurrence and survival. Results: The total number of lymph nodes studied was 3,648, with an average of 34.7 lymph nodes/neck specimens. The most frequent lymph node reactivity patterns were sinusal histiocytosis (50 cases), paracortical hyperplasia (35 cases), and follicular hyperplasia (20 cases). There was no statistical association of these individual patterns with recurrence rate (p = 0.98) or mortality (p = 0.49). However, there was a statistically significant association between paracortical hyperplasia pattern (related to cellular lymph node immunity) and improved five-year survival (76 versus 60%; log-rank = 0.05). Conclusions: There was a positive correlation between stimulated cellular lymph node pattern and improved 5-year survival rate in patients with pN0 laryngeal squamous cell carcinoma, suggesting the indication of adjuvant treatment for those individuals with decreased immune response, even in the absence of pathologic metastases detected by the usual methods.