Who’s counting?

Despite the fact that head and neck cancers, as an entity, are increasingly divergent in their biology, behavior, and treatment, they continue to be staged according to very similar criteria. Nodal size and laterality are widely-recognized as the primary drivers of lymph node status. A new NCDB analysis sought to establish the relationship between the simple number of involved lymph nodes and outcomes for laryngeal and hypopharyngeal cancer. The traditional nodal characteristics used to stage patients--size and laterality--had no influence in multivariable analysis on survival. The nodal factors that did influence survival were the number of nodes and extranodal extension. Interestingly, the risk of mortality increased linearly with number of nodes without a plateau: the hazard ratio of death (per node!) was a striking 1.19. This is interesting because we currently don’t factor into treatment algorithms the number of involved nodes on a continuum, and this could put an interesting new spin on post-op chemo recs. Does anyone else see another unplanned retrospective pooled subgroup analysis in our future?