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Extent of extracapsular spread
Author(s) -
Greenberg Jayson S.,
Fowler Robert,
Gomez Jose,
Mo Vivian,
Roberts Dianna,
El Naggar Adel K.,
Myers Jeffrey N.
Publication year - 2003
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.11202
Subject(s) - medicine , lymph , lymph node , metastasis , radiation therapy , tongue , epidermoid carcinoma , basal cell , survival rate , surgery , oncology , pathology , cancer
BACKGROUND Extracapsular spread (ECS) of metastatic squamous cell carcinoma of the head and neck to regional lymph nodes is the most reliable predictor of poor treatment outcomes. Recently, the authors have shown that ECS is significantly associated with higher rates of locoregional recurrence, distant metastasis, and decreased survival in patients with squamous cell carcinoma of the oral tongue (SCCOT). The purpose of this review was to determine if the degree of ECS impacts distant metastasis rates and survival. METHODS Two hundred sixty‐six patients treated for SCCOT with surgery +/− adjuvant radiotherapy from 1980–1995 were reviewed. The setting was a tertiary referral center. The extent of ECS on histopathologic review of involved lymph nodes was measured from the capsular margin to the farthest perinodal extension in mm. Extent of ECS and the number of pathologic lymph nodes with or without ECS were analyzed for disease‐free interval, survival rates, and distant metastases. RESULTS No differences in the survival of patients with ECS of ≤ 2 mm or > 2 mm was found ( P = 0.92). Patients with both ECS and multiple positive lymph nodes had decreased overall survival ( P = 0.0003), disease‐specific survival ( P = 0.0005), and a shorter disease‐free interval ( P = 0.019) when compared with those with a single positive lymph node with ECS. Those with multiple ECS+ lymph nodes had the worst prognosis ( P = 0.001). CONCLUSIONS Based on these findings, the authors recommended that all patients with SCCOT with ECS or multiple positive lymph nodes with or without ECS on pathologic review be considered for clinical trials that intensify regional and systemic adjuvant therapy. Cancer 2003;97:1464–70. © 2003 American Cancer Society. DOI 10.1002/cncr.11202