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. 2025 Mar 18;10(2):e70120.
doi: 10.1002/lio2.70120. eCollection 2025 Apr.

Neck Dissection and Survival Among Head and Neck Cancer Patients Undergoing Adjuvant Immunotherapy

Aman M Patel  1 , Afash Haleem  1 , Paul T Cowan  1 , Dylan F Roden  1
Affiliations

Neck Dissection and Survival Among Head and Neck Cancer Patients Undergoing Adjuvant Immunotherapy

Aman M Patel et al. Laryngoscope Investig Otolaryngol. .

Abstract

Background: Some studies suggest that neck dissection (ND) should be avoided in candidates for immunotherapy because lymph nodes are primary sites for immunotherapy activation. Our study investigates ND utilization and associated differences in overall survival (OS) among patients with head and neck cancer (HNC) undergoing adjuvant immunotherapy.

Methods: The 2013-2018 National Cancer Database was retrospectively reviewed for patients with HNC undergoing surgery with curative intent, and adjuvant immunotherapy. Multivariable binary logistic and Cox regression models adjusted for patient demographics, clinicopathologic features, and treatment.

Results: Of 1335 patients satisfying inclusion criteria, 679 (50.9%) patients underwent ND: 94 (13.8%) had pN0, 109 (16.1%) had pN1, 411 (60.5%) had pN2, 60 (8.8%) had pN3, and 5 (0.7%) had pNx classification. On multivariable binary logistic regression, academic treatment facility, cT4, and cN1-3 classification were associated with higher odds of undergoing ND (p < 0.05); salivary, sinonasal, oropharyngeal, hypopharyngeal, and laryngeal primary sites were associated with decreased odds (p < 0.05). Compared with those undergoing neck observation, patients undergoing ND had worse OS (49.4% vs. 61.5%, p < 0.001) on Kaplan-Meier but not multivariable Cox (adjusted hazard ratio [aHR] 1.00, 95% confidence interval [CI] 0.82-1.24, p = 0.968) regression. Compared with adjuvant immunotherapy alone, the addition of radiotherapy (aHR 0.64, 95% CI 0.44-0.93) and chemoradiotherapy (aHR 0.56, 95% CI 0.37-0.86) were associated with higher OS (p < 0.025).

Conclusion: ND was utilized in approximately 51% of patients with HNC undergoing adjuvant immunotherapy. ND was not associated with worse OS, possibly related to the high rate of pN1-3 classification.

Level of evidence: 4.

Keywords: National Cancer Database; head and neck cancer; immunotherapy; radiotherapy; survival.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Inclusion criteria. CM, clinical metastasis; NCDB, National Cancer Database.
FIGURE 2
FIGURE 2
Extent of regional lymph node examination.
FIGURE 3
FIGURE 3
Utilization of neck dissection and adjuvant therapy by age. CRT, chemoradiotherapy; ND, neck dissection; RT, radiotherapy.
FIGURE 4
FIGURE 4
Kaplan–Meier analysis of 5‐year overall survival for 656 patients undergoing neck observation and 679 patients undergoing neck dissection.
See this image and copyright information in PMC

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