TY - JOUR
T1 - Dural Invasion Predicts the Laterality and Development of Neck Metastases in Esthesioneuroblastoma
AU - Marinelli, John P.
AU - Janus, Jeffrey R.
AU - Van Gompel, Jamie J.
AU - Link, Michael J.
AU - Moore, Eric J.
AU - Van Abel, Kathryn M.
AU - Peck, Brandon W.
AU - Lohse, Christine M.
AU - Price, Daniel L.
N1 - Publisher Copyright:
©2018 Georg Thieme Verlag KG Stuttgart New York.
PY - 2018/2/22
Y1 - 2018/2/22
N2 - Objectives ;Neck metastases in patients with esthesioneuroblastoma (ENB) constitute the most significant predictor of poor long-term survival. Recently, researchers discovered the existence of dural lymphatic channels that drain to the cervical lymph nodes. From this physiologic basis, we hypothesized that patients with ENB who develop dural invasion (DI) would exhibit a proclivity for neck metastases. Design ;Retrospective review. Setting ;Tertiary referral center. Participants ;All patients treated for ENB from January 1, 1994 to December 31, 2015. Main Outcome Measures ;Incidence, laterality, and recurrence rate of neck metastases by DI status. Results ;Sixty-one patients were identified (38% female; median age 49, range, 10-80), 34 (56%) of whom had DI and 27 (44%) did not. Of patients with DI, 50% presented with or developed neck disease following treatment compared with just 22% of those without DI (p = 0.026). Bilateral neck disease was more common in patients with DI (11/34, 32%) compared with those without (2/27, 7%) (p = 0.018). Five-year regional recurrence-free survival rates were 88% for those without and 64% for those with DI (p = 0.022). Kadish C patients with DI were more likely to develop regional recurrence when compared with Kadish C without DI and Kadish A/B (p = 0.083). Further, Kadish C patients with DI displayed worse overall survival than Kadish C without DI and Kadish A/B. Kadish D patients displayed the worst overall survival. The difference in overall survival among these four groups was significant (p < 0.001). Conclusion ;DI by ENB is associated with increased incidence of cervical nodal metastases, bilateral neck disease, worse regional recurrence-free survival, and poorer overall survival. These data support the division of Kadish C by DI status.
AB - Objectives ;Neck metastases in patients with esthesioneuroblastoma (ENB) constitute the most significant predictor of poor long-term survival. Recently, researchers discovered the existence of dural lymphatic channels that drain to the cervical lymph nodes. From this physiologic basis, we hypothesized that patients with ENB who develop dural invasion (DI) would exhibit a proclivity for neck metastases. Design ;Retrospective review. Setting ;Tertiary referral center. Participants ;All patients treated for ENB from January 1, 1994 to December 31, 2015. Main Outcome Measures ;Incidence, laterality, and recurrence rate of neck metastases by DI status. Results ;Sixty-one patients were identified (38% female; median age 49, range, 10-80), 34 (56%) of whom had DI and 27 (44%) did not. Of patients with DI, 50% presented with or developed neck disease following treatment compared with just 22% of those without DI (p = 0.026). Bilateral neck disease was more common in patients with DI (11/34, 32%) compared with those without (2/27, 7%) (p = 0.018). Five-year regional recurrence-free survival rates were 88% for those without and 64% for those with DI (p = 0.022). Kadish C patients with DI were more likely to develop regional recurrence when compared with Kadish C without DI and Kadish A/B (p = 0.083). Further, Kadish C patients with DI displayed worse overall survival than Kadish C without DI and Kadish A/B. Kadish D patients displayed the worst overall survival. The difference in overall survival among these four groups was significant (p < 0.001). Conclusion ;DI by ENB is associated with increased incidence of cervical nodal metastases, bilateral neck disease, worse regional recurrence-free survival, and poorer overall survival. These data support the division of Kadish C by DI status.
KW - dural invasion
KW - elective neck treatment
KW - esthesioneuroblastoma
KW - neck metastases
KW - olfactory neuroblastoma
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U2 - 10.1055/s-0038-1625977
DO - 10.1055/s-0038-1625977
M3 - Article
AN - SCOPUS:85042590183
SN - 2193-634X
VL - 79
SP - 495
EP - 500
JO - Journal of Neurological Surgery, Part B: Skull Base
JF - Journal of Neurological Surgery, Part B: Skull Base
IS - 5
ER -