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Head and Neck Surgery

(015) Addressing the Neck: NCDB Study of Clinically Node-Negative Supraglottic Cancer

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Elsie Barry

    Elsie Barry, BS
    University of Missouri School of Medicine
    Columbia, Missouri, United States

    • Co-Author(s)

  • Elsie Barry

    Elsie Barry, BS
    University of Missouri School of Medicine
    Columbia, Missouri, United States

    • Presenting Author(s)

  • KS

    Kelly L. Schmidt, MD

    Kelly L. Schmidt, MD
    Department of Otolaryngology Head and Neck Surgery, University of Missouri-Columbia
    Columbia, Missouri, United States

    • Co-Author(s)

  • KS

    Kelly L. Schmidt, MD

    Kelly L. Schmidt, MD
    Department of Otolaryngology Head and Neck Surgery, University of Missouri-Columbia
    Columbia, Missouri, United States

  • MT

    Michael C. Topf, MD

    Assistant Professor of Otolaryngology - Head and Neck Surgery
    Vanderbilt University Medical Center
    Nashville, TN, United States

    • Senior Author(s)

  • PT

    Patrick T. Tassone, MD

    Patrick Tassone, MD
    Department of Otolaryngology Head and Neck Surgery, University of Missouri
    Columbia, Missouri, United States

Disclosure(s):
Elsie Barry, Other: No relevant relationships to disclose.
Kelly L. Schmidt, MD: No relevant relationships to disclose.
Patrick T. Tassone, MD: No relevant relationships to disclose.


Introduction: Management of the clinically node-negative neck in surgically managed supraglottic squamous cell carcinoma (SCCa) remains controversial. We sought to evaluate the impact of elective neck dissection (END) on oncologic outcomes in surgically managed supraglottic SCCa using the National Cancer Database (NCDB).

Methods: Patients with previously untreated, clinically node-negative (cN0) supraglottic SCCa treated with partial laryngectomy were queried from NCDB. Patients without known neck management were excluded. Patients were grouped by whether END was performed, and groups were compared by Chi-square and t tests. Univariable and multivariable Cox proportional hazard analysis was used to examine associations between patient factors and OS, which was censored at five years.

Results: A total of 1,352 patients met eligibility criteria. 811 (60%) patients had END performed with occult nodal metastasis identified in 177 (22%) patients. END was more likely to be performed at academic centers than non-academic centers (64% vs. 52%, p< 0.001). Patients who underwent END were less likely to receive adjuvant radiation (26% vs. 40%, p< 0.001). END was associated with improved OS overall on univariable analysis (HR 0.83, 95% CI 0.69-0.98, p=0.026), but not on multivariable analysis (HR 0.90, 95% CI 0.74-1.10, p=0.291).

Conclusions: In this NCDB study, 22% of cN0 supraglottic SCCa patients had occult nodal metastatic disease. Despite this, 40% of patients do not receive END at the time of primary resection. Patients who receive END for supraglottic SCCa are more likely to avoid adjuvant radiation without impacting OS.