Elective Neck Dissection in cT1‐4 N0M0 Head and Neck Spindle Cell Carcinoma

Abstract Objective To investigate the survival benefit of elective neck dissection (END) over neck observation in surgically resected cT1‐4 N0M0 head and neck spindle cell carcinoma (HNSpCC). Study Design Retrospective cohort study. Setting The 2006 to 2018 hospital‐based National Cancer Database (NCDB). Methods Patients with surgically resected cT1‐4 N0M0 HNSpCC were selected. Linear, binary logistic, Kaplan‐Meier, and Cox proportional hazards regression models were implemented. Results Of 815 patients satisfying inclusion criteria, a high proportion were male (72.4%) and white (86.0%) with disease of the larynx (43.8%) classified as high grade (87.7%) and cT1‐2 (74.8%). In total, 235 (28.8%) patients underwent END. END utilization between 2006 and 2018 increased for cT1‐2 disease (4.0% vs 30.5%, R 2 = 0.731) and for cT3‐4 disease (15.4% vs 84.6%, R 2 = 0.606). In total, 58 (24.7%) ENDs detected occult nodal metastases (ONMs). The 5‐year overall survival (OS) of patients undergoing neck observation and END was 62% and 54%, respectively ( P = .215). Among patients undergoing END, patients with ONM had worse 5‐year OS than those without ONM (38% vs 60%, P < .001). On multivariable Cox regression, END was not associated with OS (adjusted hazard ratio [aHR] 0.74, 95% CI 0.68‐1.32, P = .735); ONM (hazard ratio [HR] 2.01, 95% CI 1.29‐3.12, P = .002) was associated with worse OS. Conclusion END is performed in a high proportion (30%) of patients with cN0M0 HNSpCC but is not associated with higher OS. The rate of ONM approaching 25% and the association between ONM and worse OS, however, justify consideration of END in HNSpCC. Level of Evidence: 4.