Histopathologically Positive Regional Neck Node Metastasis Among Patients with Laryngeal Squamous Cell Carcinoma

Objective: To determine the patterns of regional neck node metastasis in laryngeal squamous cell carcinoma in Filipinos according to subsite and clinical stage and to determine possible factors associated with level V involvement. Methods: Design: Retrospective Case Series Setting: Tertiary National University Hospital Participants: A chart review was conducted for patients diagnosed with laryngeal squamous cell carcinoma who underwent laryngectomy with neck dissection from January 2011 to April 2015. Medical information obtained included demographics, clinical parameters and histopathologic reports of nodal involvement. The rate and location of positive neck nodes was recorded according to clinical stage and primary subsite. Fisher exact test was used to determine significant risk factors for level V cervical lymph node involvement. Results: From the 56 patients included, most were male with an average age of 61 years. Most patients had cancer originating from the glottic subsite with the majority being staged III and IVA according to the TNM classification. Histopathologically, positive neck nodes were centered at levels II to IV. No significant association was seen between level V involvement and the studied clinicopathologic factors (age, sex, tumor differentiation, subsite involvement, involvement of other neck node levels). Conclusion: Cervical neck node levels II, III and IV are the most commonly involved in neck dissection with many being positive for nodal metastasis for these levels. Level V nodes may be removed when clinically positive, but elective neck dissection may exclude this level. The current practice of neck dissection appears to be appropriate in terms of selecting the most likely locations of metastatic spread. Further study is recommended with a greater population and standardized levels of neck dissection.