Association of Pathologic Nodal Metastasis Count With Oncologic Outcomes in Head and Neck Cancer: A Secondary Analysis of RTOG 9501, RTOG 0234, and EORTC 22931

Number of +LNs was validated as an independent factor associated with worse OS and DFS without plateau in a secondary analysis of 3 RCTs of patients with HNSCC undergoing surgery and post-operative RT. For patients with ≤5 +LNs, increased mortality was driven by both increased LRR and DM risk. However, beyond 5 +LNs, additional mortality increases were driven entirely by increasing DM. These changing patterns of recurrence as a function of quantitative nodal burden can help inform future clinical trials attempted to improve outcomes through treatment intensification.