IMR Press / FBL / Volume 26 / Issue 7 / DOI: 10.52586/4937
Open Access Systematic Review
Nodal tumor volume as a prognostic factor for head and neck squamous cell carcinoma: a systematic review
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1 1st Department of Otolaryngology - Head & Neck Surgery, Medical School, National & Kapodistrian University of Athens (NKUA), Hippokrateio Hospital, 11527 Athens, Greece
2 ENT Department, ELPIS General Hospital, 11528 Athens, Greece
3 Izmir Biomedicine and Genome Center (IBG), 35340 Balcova, Izmir, Turkey
4 Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, 35340 Balcova, Izmir, Turkey
5 Department of Molecular Biology and Genetics, Faculty of Science, Muğla Sıtkı Koçman University, 48000 Kötekli, Muğla, Turkey
6 DNA Damage Laboratory, Department of Physics, School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), 15780 Athens, Greece
*Correspondence: (Alexandros G. Georgakilas); (Efthymios Kyrodimos)
These authors contributed equally.
Front. Biosci. (Landmark Ed) 2021, 26(7), 235–245;
Submitted: 14 March 2021 | Revised: 10 May 2021 | Accepted: 21 May 2021 | Published: 30 July 2021
Copyright: © 2021 The Author(s). Published by BRI.
This is an open access article under the CC BY 4.0 license (

Introduction: Several studies suggest that there is an association between the metastatic nodal tumor volume and the clinical outcome in patients with solid cancers. However, despite the prognostic potential of nodal volume, a standardized method for estimating the nodal volumetric parameters is lacking. Herein, we conducted a systematic review of the published scientific literature towards investigating the prognostic value of nodal volume in the carcinomas of head and neck, taking into consideration the primary tumor site and the human papillomavirus (HPV) status. Methodological issues: For this purpose, the biomedical literature database PubMed/MEDLINE was searched for studies relevant to the relationship of nodal volume to the treatment outcome and survival in head and neck squamous cell carcinoma (HNSCC) patients. Collectively, based on stringent inclusion/exclusion criteria, 23 eligible studies were included in the present systematic review. Results: On the basis of our findings, nodal volume is suggested to be strongly associated with clinical outcomes in HNSCC patients. Of particular note, there is an indication that nodal volume is an independent factor for further risk stratification for recurrence-free survival in patients with squamous cell carcinoma of the pharynx (oropharynx and hypopharynx). Extranodal extension (ENE) and HPV status should be also taken into consideration in further studies.

Head and neck cancers
Nodal tumor volume
Clinical outcomes
Systematic review
Fig. 1.
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