Aurit S

Background: The prognostic implication of tumor location in breast cancer remains unclear. Previous studies suggested that inner and lower quadrant-located tumors were associated with decreased survival.

Methods: The NCDB was quired to identify AJCC clinical stage I-III first female breast cancer patients with unilateral disease who underwent breast-conserving surgery from 2010 to 2016. Three mutually exclusive groups were created based on tumor location, which included outer (upper and lower outer quadrants), central, and inner (upper and lower inner quadrants) zones of the breast. Clinical and demographic variables were obtained. Unadjusted survival differences were examined with Kaplan- Meier method. Multivariate Cox regression model was employed to examine the association between zone group and survival.

Results: 125,800 patients were identified including 83,558 (66.4%), 6,764 (5.4%), and 35,449 (28.2%) patients within the outer, central, and inner zones. There was evidence of a difference in age and tumor size based on site (P<0.001). It was also found that there was an association between tumor zone and each of the following (P<0.05): race and ethnicity, Charlson-Deyo score, insurance, income, education, facility type, laterality, histology, utilization of chemotherapy, ER status, PR status, and HER2 status. There was no relationship between site and unadjusted survival (P=0.905). After adjusting for all else, a 5.7% decreased the risk of death was found upon the comparison of the outer vs. inner zone of the breast (95% CI: 0.4%-11.8%; P=0.037). In general, older African American Medicaid patients with increased Charlson-Deyo scores and hormone receptor-negative breast cancers from lower-income areas had decreased survival.

Conclusion: Outer zone breast cancer has a more favorable survival advantage when compared with inner zone cancers. A finding that warrants re-evaluation of the management approach to inner zone breast cancer.

Background: The prognostic implication of tumor location in breast cancer remains unclear. Previous studies suggested that inner and lower quadrant-located tumors were associated with decreased survival.

Methods: The NCDB was quired to identify AJCC clinical stage I-III first female breast cancer patients with unilateral disease who underwent breast-conserving surgery from 2010 to 2016. Three mutually exclusive groups were created based on tumor location, which included outer (upper and lower outer quadrants), central, and inner (upper and lower inner quadrants) zones of the breast. Clinical and demographic variables were obtained. Unadjusted survival differences were examined with Kaplan- Meier method. Multivariate Cox regression model was employed to examine the association between zone group and survival.

Results: 125,800 patients were identified including 83,558 (66.4%), 6,764 (5.4%), and 35,449 (28.2%) patients within the outer, central, and inner zones. There was evidence of a difference in age and tumor size based on site (P<0.001). It was also found that there was an association between tumor zone and each of the following (P<0.05): race and ethnicity, Charlson-Deyo score, insurance, income, education, facility type, laterality, histology, utilization of chemotherapy, ER status, PR status, and HER2 status. There was no relationship between site and unadjusted survival (P=0.905). After adjusting for all else, a 5.7% decreased the risk of death was found upon the comparison of the outer vs. inner zone of the breast (95% CI: 0.4%-11.8%; P=0.037). In general, older African American Medicaid patients with increased Charlson-Deyo scores and hormone receptor-negative breast cancers from lower-income areas had decreased survival.

Conclusion: Outer zone breast cancer has a more favorable survival advantage when compared with inner zone cancers. A finding that warrants re-evaluation of the management approach to inner zone breast cancer.

Background: The prognostic implication of tumor location in breast cancer remains unclear. Previous studies suggested that inner and lower quadrant-located tumors were associated with decreased survival.

Methods: The NCDB was quired to identify AJCC clinical stage I-III first female breast cancer patients with unilateral disease who underwent breast-conserving surgery from 2010 to 2016. Three mutually exclusive groups were created based on tumor location, which included outer (upper and lower outer quadrants), central, and inner (upper and lower inner quadrants) zones of the breast. Clinical and demographic variables were obtained. Unadjusted survival differences were examined with Kaplan- Meier method. Multivariate Cox regression model was employed to examine the association between zone group and survival.

Results: 125,800 patients were identified including 83,558 (66.4%), 6,764 (5.4%), and 35,449 (28.2%) patients within the outer, central, and inner zones. There was evidence of a difference in age and tumor size based on site (P<0.001). It was also found that there was an association between tumor zone and each of the following (P<0.05): race and ethnicity, Charlson-Deyo score, insurance, income, education, facility type, laterality, histology, utilization of chemotherapy, ER status, PR status, and HER2 status. There was no relationship between site and unadjusted survival (P=0.905). After adjusting for all else, a 5.7% decreased the risk of death was found upon the comparison of the outer vs. inner zone of the breast (95% CI: 0.4%-11.8%; P=0.037). In general, older African American Medicaid patients with increased Charlson-Deyo scores and hormone receptor-negative breast cancers from lower-income areas had decreased survival.

Conclusion: Outer zone breast cancer has a more favorable survival advantage when compared with inner zone cancers. A finding that warrants re-evaluation of the management approach to inner zone breast cancer.

Background: Myxoid liposarcomas (MLS) are intermediate to high grade liposarcomas, which are the most common type of soft tissue sarcoma. Although MLS most frequently develops in the legs, it can arise in any of the body’s soft tissue adipose. Previous studies of MLS survival have been limited in terms of geography, cohort size, variety of treatment settings, and assessment of primary site role. We retrospectively studied survival data for a nationwide cohort of MLS patients to identify prognostic factors and assess their effects on survival.

Methods: Using the National Cancer Database, we obtained data on 4636 patients diagnosed with MLS (ICD-O-3 8852) between 2004 and 2016. 5- and 10-year survival curves were estimated with Kaplan-Meier analysis and compared with log-rank analysis. Cox hazard regression was also used to compare multiple variables’ effects on survival.

Results: Approximately 59.2% of the cohort was male with a median age of presentation of 49 years. The most common site of metastasis was the bone followed by lung, liver, and brain. The majority (46.8%) of patients were stage I at time of diagnosis, followed by stage II with 18.1%, stage III with 13.1%, and stage IV at 5.3%. Overall 5- and 10-year survival probabilities for the cohort were 76.1% and 62.0%. Female patients (5-year: 79.6% and 10-year: 65.5%) had better survivals than male patients (5-year: 73.8% and 10-years: 59.6%). As stage increased, overall survival decreased with stage IV patients having 5- and 10-year survival probabilities of 21.2% and 9.4%, respectively. Patients with tumors localized to the extremities (5-year: 81.2%) had the best overall survival followed by tumors in the head or neck (5-year: 79.9%), pelvis (5-year: 77.3%), pelvis (5-year: 78.0%), thorax or trunk (5-year: 66.5%), and the retroperitoneum or abdomen (5-year: 53.1%). Finally, adjuvant radiation treatment correlated with decreased mortality to surgical resection of primary tumor alone (HR: 0.847; 95% CI: 0.726-0.989), whereas adjuvant chemotherapy correlated with increased mortality (HR: 2.769; 95% CI: 1.995-3.841).

Conclusion: Primary anatomical site was determined to be a major prognostic factor along with treatment facility type, sex, stage, and surgical margins for patients with myxoid liposarcoma.

Background: Myxoid liposarcomas (MLS) are intermediate to high grade liposarcomas, which are the most common type of soft tissue sarcoma. Although MLS most frequently develops in the legs, it can arise in any of the body’s soft tissue adipose. Previous studies of MLS survival have been limited in terms of geography, cohort size, variety of treatment settings, and assessment of primary site role. We retrospectively studied survival data for a nationwide cohort of MLS patients to identify prognostic factors and assess their effects on survival.

Methods: Using the National Cancer Database, we obtained data on 4636 patients diagnosed with MLS (ICD-O-3 8852) between 2004 and 2016. 5- and 10-year survival curves were estimated with Kaplan-Meier analysis and compared with log-rank analysis. Cox hazard regression was also used to compare multiple variables’ effects on survival.

Results: Approximately 59.2% of the cohort was male with a median age of presentation of 49 years. The most common site of metastasis was the bone followed by lung, liver, and brain. The majority (46.8%) of patients were stage I at time of diagnosis, followed by stage II with 18.1%, stage III with 13.1%, and stage IV at 5.3%. Overall 5- and 10-year survival probabilities for the cohort were 76.1% and 62.0%. Female patients (5-year: 79.6% and 10-year: 65.5%) had better survivals than male patients (5-year: 73.8% and 10-years: 59.6%). As stage increased, overall survival decreased with stage IV patients having 5- and 10-year survival probabilities of 21.2% and 9.4%, respectively. Patients with tumors localized to the extremities (5-year: 81.2%) had the best overall survival followed by tumors in the head or neck (5-year: 79.9%), pelvis (5-year: 77.3%), pelvis (5-year: 78.0%), thorax or trunk (5-year: 66.5%), and the retroperitoneum or abdomen (5-year: 53.1%). Finally, adjuvant radiation treatment correlated with decreased mortality to surgical resection of primary tumor alone (HR: 0.847; 95% CI: 0.726-0.989), whereas adjuvant chemotherapy correlated with increased mortality (HR: 2.769; 95% CI: 1.995-3.841).

Conclusion: Primary anatomical site was determined to be a major prognostic factor along with treatment facility type, sex, stage, and surgical margins for patients with myxoid liposarcoma.

Background: Myxoid liposarcomas (MLS) are intermediate to high grade liposarcomas, which are the most common type of soft tissue sarcoma. Although MLS most frequently develops in the legs, it can arise in any of the body’s soft tissue adipose. Previous studies of MLS survival have been limited in terms of geography, cohort size, variety of treatment settings, and assessment of primary site role. We retrospectively studied survival data for a nationwide cohort of MLS patients to identify prognostic factors and assess their effects on survival.

Methods: Using the National Cancer Database, we obtained data on 4636 patients diagnosed with MLS (ICD-O-3 8852) between 2004 and 2016. 5- and 10-year survival curves were estimated with Kaplan-Meier analysis and compared with log-rank analysis. Cox hazard regression was also used to compare multiple variables’ effects on survival.

Results: Approximately 59.2% of the cohort was male with a median age of presentation of 49 years. The most common site of metastasis was the bone followed by lung, liver, and brain. The majority (46.8%) of patients were stage I at time of diagnosis, followed by stage II with 18.1%, stage III with 13.1%, and stage IV at 5.3%. Overall 5- and 10-year survival probabilities for the cohort were 76.1% and 62.0%. Female patients (5-year: 79.6% and 10-year: 65.5%) had better survivals than male patients (5-year: 73.8% and 10-years: 59.6%). As stage increased, overall survival decreased with stage IV patients having 5- and 10-year survival probabilities of 21.2% and 9.4%, respectively. Patients with tumors localized to the extremities (5-year: 81.2%) had the best overall survival followed by tumors in the head or neck (5-year: 79.9%), pelvis (5-year: 77.3%), pelvis (5-year: 78.0%), thorax or trunk (5-year: 66.5%), and the retroperitoneum or abdomen (5-year: 53.1%). Finally, adjuvant radiation treatment correlated with decreased mortality to surgical resection of primary tumor alone (HR: 0.847; 95% CI: 0.726-0.989), whereas adjuvant chemotherapy correlated with increased mortality (HR: 2.769; 95% CI: 1.995-3.841).

Conclusion: Primary anatomical site was determined to be a major prognostic factor along with treatment facility type, sex, stage, and surgical margins for patients with myxoid liposarcoma.

Background: Pleomorphic liposarcomas is an aggressive, high grade subtype of soft tissue sarcoma representing < 15% of liposarcomas. It most commonly arises in the retroperitoneum and proximal upper extremities. Current prognostic factors are centered around staging, which accounts for the grade, size, and location of the tumor in relation to the superficial fascia.

Methods: A total of 1778 patients diagnosed with pleomorphic liposarcoma were identified in the National Cancer Database and stratified by primary anatomical site: head/neck, upper limb, lower limb/hip, thorax/lung, pelvis, and retroperitoneum/abdomen. Kaplan-Meier survival tables were produced to estimate 1-, 5-, and 10-year overall survival. Log-rank tests with a Bonferroni correction for multiple comparisons and a multivariable Cox proportional hazards analysis were utilized to compare the primary site groups; P < 0.05 was considered significant.

Results: The most common primary anatomical site was the lower limb/hip. The head/neck primary anatomical site demonstrated the highest 10-year overall survival probability, while retroperitoneum/abdomen had the lowest (50% and 18.4%, respectively). Median survival was 9.19 years for the head/neck group, and 3.08 years for the retroperitoneum/abdomen group. Significant overall survival differences were found between the retroperitoneum/abdomen group and each of the following groups: head/neck (P=0.001), upper limb (P<0.001), lower limb/hip (P<0.001), and pelvis (P=0.001). After adjusting for age, biological sex, race and ethnicity, Charlson-Deyo comorbidity index, and AJCC pathologic stage, a 48.4% increased risk of death was found for retroperitoneum/abdomen vs. lower limb/hip primary site (95% CI: 14.6% to 92.1%; P=0.003). Thorax/lung vs. lower limb/hip was also associated with a 55.1% increased risk of death (95% CI: 8.4% to 121.9%; P=0.016).

Conclusion: The current prognostic modality for pleomorphic liposarcoma is limited. There are statistically significant differences in survival based on primary anatomical sites, which may serve as a useful prognostic indicator. Tumors manifesting in the retroperitoneum/abdomen demonstrated the lowest survival.

Background: Pleomorphic liposarcomas is an aggressive, high grade subtype of soft tissue sarcoma representing < 15% of liposarcomas. It most commonly arises in the retroperitoneum and proximal upper extremities. Current prognostic factors are centered around staging, which accounts for the grade, size, and location of the tumor in relation to the superficial fascia.

Methods: A total of 1778 patients diagnosed with pleomorphic liposarcoma were identified in the National Cancer Database and stratified by primary anatomical site: head/neck, upper limb, lower limb/hip, thorax/lung, pelvis, and retroperitoneum/abdomen. Kaplan-Meier survival tables were produced to estimate 1-, 5-, and 10-year overall survival. Log-rank tests with a Bonferroni correction for multiple comparisons and a multivariable Cox proportional hazards analysis were utilized to compare the primary site groups; P < 0.05 was considered significant.

Results: The most common primary anatomical site was the lower limb/hip. The head/neck primary anatomical site demonstrated the highest 10-year overall survival probability, while retroperitoneum/abdomen had the lowest (50% and 18.4%, respectively). Median survival was 9.19 years for the head/neck group, and 3.08 years for the retroperitoneum/abdomen group. Significant overall survival differences were found between the retroperitoneum/abdomen group and each of the following groups: head/neck (P=0.001), upper limb (P<0.001), lower limb/hip (P<0.001), and pelvis (P=0.001). After adjusting for age, biological sex, race and ethnicity, Charlson-Deyo comorbidity index, and AJCC pathologic stage, a 48.4% increased risk of death was found for retroperitoneum/abdomen vs. lower limb/hip primary site (95% CI: 14.6% to 92.1%; P=0.003). Thorax/lung vs. lower limb/hip was also associated with a 55.1% increased risk of death (95% CI: 8.4% to 121.9%; P=0.016).

Conclusion: The current prognostic modality for pleomorphic liposarcoma is limited. There are statistically significant differences in survival based on primary anatomical sites, which may serve as a useful prognostic indicator. Tumors manifesting in the retroperitoneum/abdomen demonstrated the lowest survival.

Background: Pleomorphic liposarcomas is an aggressive, high grade subtype of soft tissue sarcoma representing < 15% of liposarcomas. It most commonly arises in the retroperitoneum and proximal upper extremities. Current prognostic factors are centered around staging, which accounts for the grade, size, and location of the tumor in relation to the superficial fascia.

Methods: A total of 1778 patients diagnosed with pleomorphic liposarcoma were identified in the National Cancer Database and stratified by primary anatomical site: head/neck, upper limb, lower limb/hip, thorax/lung, pelvis, and retroperitoneum/abdomen. Kaplan-Meier survival tables were produced to estimate 1-, 5-, and 10-year overall survival. Log-rank tests with a Bonferroni correction for multiple comparisons and a multivariable Cox proportional hazards analysis were utilized to compare the primary site groups; P < 0.05 was considered significant.

Results: The most common primary anatomical site was the lower limb/hip. The head/neck primary anatomical site demonstrated the highest 10-year overall survival probability, while retroperitoneum/abdomen had the lowest (50% and 18.4%, respectively). Median survival was 9.19 years for the head/neck group, and 3.08 years for the retroperitoneum/abdomen group. Significant overall survival differences were found between the retroperitoneum/abdomen group and each of the following groups: head/neck (P=0.001), upper limb (P<0.001), lower limb/hip (P<0.001), and pelvis (P=0.001). After adjusting for age, biological sex, race and ethnicity, Charlson-Deyo comorbidity index, and AJCC pathologic stage, a 48.4% increased risk of death was found for retroperitoneum/abdomen vs. lower limb/hip primary site (95% CI: 14.6% to 92.1%; P=0.003). Thorax/lung vs. lower limb/hip was also associated with a 55.1% increased risk of death (95% CI: 8.4% to 121.9%; P=0.016).

Conclusion: The current prognostic modality for pleomorphic liposarcoma is limited. There are statistically significant differences in survival based on primary anatomical sites, which may serve as a useful prognostic indicator. Tumors manifesting in the retroperitoneum/abdomen demonstrated the lowest survival.

Background: Liposarcoma is the most common malignant soft tissue sarcoma (STS). Surgical resection is the most utilized therapeutic option. In this study, we aim to explore the effects of varying degrees of surgical margins on survival in patients with dedifferentiated liposarcoma (DDLPS).

Methods: The National Cancer Database (NCDB) was used to select patients with DDLPS to determine if surgical margins and other variables were associated with decreased overall survival after accounting for age, gender, race, Charlson-Deyo score, anatomic site, treatment approach, tumor size, tumor grade, and presence of metastases through multivariable analysis.

Results: Of the 1004 selected patients, 64.4% were male, 87.0% were white, and the median age was 63 years. About 95% had no metastases at the time of diagnosis, and 91.5% had high grade liposarcoma. For the status of surgical margins, 50.8% had no residual tumors, 26.1% had microscopic residual tumors, 4.3% had macroscopic residual tumors. In general, the risk of death was higher for older males (25.8% increased risk of mortality) and those with metastases (312.9% increased risk of mortality) as well as patients with high grade liposarcoma (112.4% increased risk of mortality). Patients with macroscopic residual tumors in comparison to those with no residual tumors had a 96.7% increased risk of death (HR 95% CI:1.24 to 3.13; P=0.004).

Conclusion: Older age, presence of metastasis, male patients, retroperitoneal/abdomen primary site, highgrade tumors, and macroscopic or residual tumor present after surgery lead to an increased risk of mortality. These outcomes highlight the importance and benefits of negative or complete surgical margins as prognostic indicators for patients with DDLPS, especially considering that resection is the most commonly utilized therapeutic option. The NCDB contains about 70% of cancer incidents within the US, therefore a future study incorporating the Surveillance, Epidemiology, and End Results (SEER) registry could enhance and possibly add to the results brought forth by this study.

Background: Liposarcoma is the most common malignant soft tissue sarcoma (STS). Surgical resection is the most utilized therapeutic option. In this study, we aim to explore the effects of varying degrees of surgical margins on survival in patients with dedifferentiated liposarcoma (DDLPS).

Methods: The National Cancer Database (NCDB) was used to select patients with DDLPS to determine if surgical margins and other variables were associated with decreased overall survival after accounting for age, gender, race, Charlson-Deyo score, anatomic site, treatment approach, tumor size, tumor grade, and presence of metastases through multivariable analysis.

Results: Of the 1004 selected patients, 64.4% were male, 87.0% were white, and the median age was 63 years. About 95% had no metastases at the time of diagnosis, and 91.5% had high grade liposarcoma. For the status of surgical margins, 50.8% had no residual tumors, 26.1% had microscopic residual tumors, 4.3% had macroscopic residual tumors. In general, the risk of death was higher for older males (25.8% increased risk of mortality) and those with metastases (312.9% increased risk of mortality) as well as patients with high grade liposarcoma (112.4% increased risk of mortality). Patients with macroscopic residual tumors in comparison to those with no residual tumors had a 96.7% increased risk of death (HR 95% CI:1.24 to 3.13; P=0.004).

Conclusion: Older age, presence of metastasis, male patients, retroperitoneal/abdomen primary site, highgrade tumors, and macroscopic or residual tumor present after surgery lead to an increased risk of mortality. These outcomes highlight the importance and benefits of negative or complete surgical margins as prognostic indicators for patients with DDLPS, especially considering that resection is the most commonly utilized therapeutic option. The NCDB contains about 70% of cancer incidents within the US, therefore a future study incorporating the Surveillance, Epidemiology, and End Results (SEER) registry could enhance and possibly add to the results brought forth by this study.

Background: Liposarcoma is the most common malignant soft tissue sarcoma (STS). Surgical resection is the most utilized therapeutic option. In this study, we aim to explore the effects of varying degrees of surgical margins on survival in patients with dedifferentiated liposarcoma (DDLPS).

Methods: The National Cancer Database (NCDB) was used to select patients with DDLPS to determine if surgical margins and other variables were associated with decreased overall survival after accounting for age, gender, race, Charlson-Deyo score, anatomic site, treatment approach, tumor size, tumor grade, and presence of metastases through multivariable analysis.

Results: Of the 1004 selected patients, 64.4% were male, 87.0% were white, and the median age was 63 years. About 95% had no metastases at the time of diagnosis, and 91.5% had high grade liposarcoma. For the status of surgical margins, 50.8% had no residual tumors, 26.1% had microscopic residual tumors, 4.3% had macroscopic residual tumors. In general, the risk of death was higher for older males (25.8% increased risk of mortality) and those with metastases (312.9% increased risk of mortality) as well as patients with high grade liposarcoma (112.4% increased risk of mortality). Patients with macroscopic residual tumors in comparison to those with no residual tumors had a 96.7% increased risk of death (HR 95% CI:1.24 to 3.13; P=0.004).

Conclusion: Older age, presence of metastasis, male patients, retroperitoneal/abdomen primary site, highgrade tumors, and macroscopic or residual tumor present after surgery lead to an increased risk of mortality. These outcomes highlight the importance and benefits of negative or complete surgical margins as prognostic indicators for patients with DDLPS, especially considering that resection is the most commonly utilized therapeutic option. The NCDB contains about 70% of cancer incidents within the US, therefore a future study incorporating the Surveillance, Epidemiology, and End Results (SEER) registry could enhance and possibly add to the results brought forth by this study.

Purpose: Lymph node yield is an independent prognostic factor for survival outcomes in patients receiving neck dissection for oral squamous cell carcinoma (SCC). This study investigates whether hospital case volume is associated with increased lymph node yield in neck dissection specimens.

Background: Guidelines recommending minimum number of lymph nodes that constitutes an adequate neck dissection have not been established. There is evidence that comprehensive neck dissections with improved lymph node yield ( 18 nodes) are associated with better survival outcomes. Recent studies have proposed this association to be a potential institutional-level quality metric. However, whetherinstitutional experience (reflected by case volume) influences the quality and comprehensiveness of neck dissection (reflected in node yield) remains unknown.

Methods: The National Cancer Database was used to identify 21,150 patients who underwent primary neck dissections for oral SCC diagnosed between 2004 and 2015. Average annual surgical volumes were calculated for each facility to stratify them into quartiles based on highest to lowest case volumes. A multivariable negative binomial mixed model was used to model the number of nodes examined at the patient level, which accommodated the clustering of hospitals and adjusted for clinical and demographic factors.

Results: The median lymph node yield for all hospitals was 27 (Interquartile Range [IQR] 16-40) nodes. Median lymph nodes examined for the quartile of highest volume hospitals was 29 (IQR 19-42). Compared to a lymph node yield of 18 (IQR 9-30) in the 3rd quartile, 17 (IQR 9-27) in the 2nd quartile, and 16 (IQR 8-26) in the lowest quartile. A Dwass, Steel, Critchlow-Fligner procedure indicated that the number of nodes were significantly different for all pairwise comparisons except between the lowest two quartiles.

Conclusions: These data suggest that for patients with oral SCC undergoing neck dissections, increase in hospital case volume is associated with higher lymph node yield. Institutions with greater experience and case volumes are more likely to consistently meet the cutoff value of lymph node yield ( 18 lymph nodes) in neck dissection specimens, that are shown to improve survival outcomes.

Purpose: Lymph node yield is an independent prognostic factor for survival outcomes in patients receiving neck dissection for oral squamous cell carcinoma (SCC). This study investigates whether hospital case volume is associated with increased lymph node yield in neck dissection specimens.

Background: Guidelines recommending minimum number of lymph nodes that constitutes an adequate neck dissection have not been established. There is evidence that comprehensive neck dissections with improved lymph node yield ( 18 nodes) are associated with better survival outcomes. Recent studies have proposed this association to be a potential institutional-level quality metric. However, whetherinstitutional experience (reflected by case volume) influences the quality and comprehensiveness of neck dissection (reflected in node yield) remains unknown.

Methods: The National Cancer Database was used to identify 21,150 patients who underwent primary neck dissections for oral SCC diagnosed between 2004 and 2015. Average annual surgical volumes were calculated for each facility to stratify them into quartiles based on highest to lowest case volumes. A multivariable negative binomial mixed model was used to model the number of nodes examined at the patient level, which accommodated the clustering of hospitals and adjusted for clinical and demographic factors.

Results: The median lymph node yield for all hospitals was 27 (Interquartile Range [IQR] 16-40) nodes. Median lymph nodes examined for the quartile of highest volume hospitals was 29 (IQR 19-42). Compared to a lymph node yield of 18 (IQR 9-30) in the 3rd quartile, 17 (IQR 9-27) in the 2nd quartile, and 16 (IQR 8-26) in the lowest quartile. A Dwass, Steel, Critchlow-Fligner procedure indicated that the number of nodes were significantly different for all pairwise comparisons except between the lowest two quartiles.

Conclusions: These data suggest that for patients with oral SCC undergoing neck dissections, increase in hospital case volume is associated with higher lymph node yield. Institutions with greater experience and case volumes are more likely to consistently meet the cutoff value of lymph node yield ( 18 lymph nodes) in neck dissection specimens, that are shown to improve survival outcomes.

Purpose: Lymph node yield is an independent prognostic factor for survival outcomes in patients receiving neck dissection for oral squamous cell carcinoma (SCC). This study investigates whether hospital case volume is associated with increased lymph node yield in neck dissection specimens.

Background: Guidelines recommending minimum number of lymph nodes that constitutes an adequate neck dissection have not been established. There is evidence that comprehensive neck dissections with improved lymph node yield ( 18 nodes) are associated with better survival outcomes. Recent studies have proposed this association to be a potential institutional-level quality metric. However, whetherinstitutional experience (reflected by case volume) influences the quality and comprehensiveness of neck dissection (reflected in node yield) remains unknown.

Methods: The National Cancer Database was used to identify 21,150 patients who underwent primary neck dissections for oral SCC diagnosed between 2004 and 2015. Average annual surgical volumes were calculated for each facility to stratify them into quartiles based on highest to lowest case volumes. A multivariable negative binomial mixed model was used to model the number of nodes examined at the patient level, which accommodated the clustering of hospitals and adjusted for clinical and demographic factors.

Results: The median lymph node yield for all hospitals was 27 (Interquartile Range [IQR] 16-40) nodes. Median lymph nodes examined for the quartile of highest volume hospitals was 29 (IQR 19-42). Compared to a lymph node yield of 18 (IQR 9-30) in the 3rd quartile, 17 (IQR 9-27) in the 2nd quartile, and 16 (IQR 8-26) in the lowest quartile. A Dwass, Steel, Critchlow-Fligner procedure indicated that the number of nodes were significantly different for all pairwise comparisons except between the lowest two quartiles.

Conclusions: These data suggest that for patients with oral SCC undergoing neck dissections, increase in hospital case volume is associated with higher lymph node yield. Institutions with greater experience and case volumes are more likely to consistently meet the cutoff value of lymph node yield ( 18 lymph nodes) in neck dissection specimens, that are shown to improve survival outcomes.