Premium
Bilateral neck metastases in upper aero‐digestive tract cancer: Emphasis on the distribution of lymphatic metastases and prognostic implications
Author(s) -
Kim Tae Wook,
Chung Man Ki,
Youm Hyeyoun,
Jeong JongIn,
Son YoungIk,
Jeong HanSin,
Baek ChungHwan
Publication year - 2011
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.22145
Subject(s) - medicine , cancer , lymphovascular invasion , metastasis , neck dissection , oncology , gastroenterology , carcinoma , pathology
Background Bilateral neck metastases (BNM) in patients with upper aero‐digestive tract cancer (UADTC) indicate a poor prognosis. However, the prognostic significance of involved neck node levels has not been determined clearly. In this study, the distribution of neck nodal metastasis and its impact on prognosis were investigated. Methods Eighty‐two previously untreated UADTC patients with BNM from 2000 to 2007 were included in these analyses. The pathology was mainly squamous cell carcinomas, including nasopharynx undifferentiated carcinoma and excluding salivary and thyroid carcinomas. The distribution and pattern of neck metastases and their prognostic significance were assessed, along with other clinical variables. Results BNM confined to the upper neck level (I–III) showed a lower rate of distant metastasis compared to BNM beyond I–III levels (13.6% vs. 47.4%, P = 0.001). There was a significant reduction in survival among patients with bilateral lower neck (IV–V) metastases on multivariate analysis (HR: 5.95, 95%CI: 1.51–23.43). However, multi‐level involvement itself did not correlate with survival. Subgroup analysis (according to nasopharynx and non‐nasopharynx cancer) also confirmed the strong trends of lower neck nodal involvement for poorer survival in both groups. Conclusion BNM at lower neck nodes can be a significant prognostic factor for early systemic dissemination and worse prognosis in UADTC patients. J. Surg. Oncol. 2012; 105:553–558. © 2011 Wiley Periodicals, Inc.