Retropharyngeal nodal metastasis related to higher rate of distant metastasis in patients with N 0 and N 1 nasopharyngeal cancer

Background Retropharyngeal lymph node (RLN) staging in nasopharyngeal carcinoma (NPC) can be controversial. Methods We retrospectively reviewed all patients with T 2–4 , N 0–1 NPC treated between 1992 and 1994 to examine if RLN metastasis resulted in an increased incidence of distant metastases. Results Of the 667 patients with NPC, 395 had T 2–4 , N 0–1 disease, 140 had N 0 , and 255 had N 1 . All had staging CT scans and were treated with radiotherapy. Median follow‐up was 8.3 years. Seventy‐four percent showed undifferentiated histology. In this cohort, 187 (47%) had RLN metastases. Multivariate analysis showed that RLN conferred a higher hazard for distant metastasis ( p = .04). Using the Kaplan–Meier method, patients with N 0 disease and RLN had a similar hazard for distant metastases as patients with N 1 disease when compared with patients with N 0 disease and without RLN. Conclusion Patients with N 0 disease and RLN appear to share a similar prognosis to patients with N 1 disease. © 2009 Wiley Periodicals, Inc. Head Neck, 2009