The prognostic value of tumor depth for cervical lymph node metastasis in hypopharyngeal and supraglottic carcinomas
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Abstract Background To analyze the prognostic value of the clinicopathological parameters of primary lesions for predicting cervical lymph node metastasis in patients with hypopharyngeal and/or supraglottic carcinoma. Methods We enrolled 127 patients with squamous cell carcinomas originating in the hypopharyngeal and/or supraglottic regions. Results Multivariate analysis identified the tumor depth as an independent predictive factor for lymph node metastasis (odds ratio, 4.959; 95% confidence interval, 2.290‐10.739; P < 0.0001) with a predictive value of 0.966. A cutoff value of 4.5 mm was determined. Conclusion The tumor depth of the primary lesion is a potent predictor of cervical lymph node metastasis in hypopharyngeal and supraglottic carcinomas. In cases with clinically negative nodal status, elective neck dissection should be adopted for patients with a tumor depth reaching 4.5 mm. Regular outpatient follow‐up is recommended for patients with a tumor depth less than 1.0 mm. Close follow‐up or preventative therapy should be considered between 1.0 and 4.5 mm.Keywords:
Neck dissection
Hypopharyngeal cancer
Primary tumor
Cervical lymph nodes
We reported the efficacy of concurrent chemoradiotherapy(CCRT)for cervical lymph node metastasis in patients with oropharyngeal or hypopharyngeal squamous cell carcinoma. The subjects were 17 patients with oropharyngeal or hypopharyngeal cancer with cervical lymph node metastasis, who underwent CCRT treatment between January 2005 and December 2009. The proportion of patients showing a complete response(CR)was 64. 7%; however, if patients without any residual viable cancer cells in the specimens obtained by neck dissection were also defined as CR, then, 82. 4% achieved CR. Thus, CCRT showed good efficacy without the need for planned neck dissection(PND). The limited recurrence cases and absence of serious complications associated with neck dissection after CCRT suggested that PND is not necessarily required. However, since assessment of cervical lymph nodes after CCRT is difficult, it would be desirable to develop a reliable examination and to study the most suitable examination for detecting the presence/absence of cervical lymph node metastasis.
Neck dissection
Hypopharyngeal cancer
Chemoradiotherapy
Cervical lymph nodes
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Oral squamous cell carcinoma （OSCC） often metastasizes to the cervical lymph nodes, but Level V metastasis is infrequent, and the prognosis of such cases is extremely poor. We describe the clinicopathological features of Level V metastasis in patients with OSCC.Four （1.9%） of 212 patients who underwent radical or modified radical neck dissection had histopathologically confirmed Level V metastasis. The primary site was the tongue in 1 patient, the lower gingiva in 2 patients, and the oral floor in 1 patient. Level V metastasis was associated with the mode of invasion, but not with T stage. In the patients with Level V metastasis, the mean total number of involved nodes on the affected side was 18.8, and the mean rate of conversion to positive status of the cervical lymph nodes was 49%. As for metastatic features, all patients showed metastasis to lymph nodes in the Level II region. The treatment outcome of Level V metastasis was poor, and all patients died of disease with a mean survival time of 9.3 months after neck dissection. In conclusion, although the frequency of Level V metastasis in oral squamous cell carcinoma was low, the prognosis was extremely poor. Furthermore, lymph-node metastases and extracapsular invasion in other regions appeared to be associated with Level V metastasis.
Neck dissection
Cervical lymph nodes
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The management of cervical lymph node metastases in well-differentiated carcinoma of the thyroid has been highly controversial. In the Department of Surgery (II), Kanazawa University Hospital, the surgical management of cervical lymph node metastases in curable well-differentiated carcinoma of the thyroid has been changed from a conservative approach to an aggressive one since 1973. In order to determine whether an aggressive approach for cervical lymph node metastases is adequate, a retrospective multivariate analysis was carried out of 218 cases of well-differentiated thyroid cancer. The patients have been followed up from 5 to 30 years. Multivariate analysis was conducted following Cox's model. As for the results, the aggressive management of cervical lymph node metastases appeared to have an impact on survival. Furthermore, age and sex were confirmed to be important prognostic factors and a partial lobectomy was confirmed to be inadequate as a type of thyroidectomy.
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Metastases from primary laryngeal and hypopharyngeal cancers to cervical lymph nodes is of great importance in designing treatment schemes. The aim of this study was to explain: (1) Do site of primary tumor, its stage and histological differentiation have significant influence on formation metastases to lymphatic nodes of the neck; (2) Do the lymph nodes metastases influence on results of treatment?We have analyzed records of 586 patients with advanced cancer of larynx and hypopharynx, who were treated by surgery between 1975 and 1990 in Department of Otolaryngology Medical University of Warsaw The clinical stages of cancer was defined according WHO classification (1987).cancer of the larynx was diagnosed in 477 cases and in 109 cases--of hypopharynx. The lymph nodes metastases were diagnosed in 152 (32%) cases with laryngeal carcinomas and in 97 (89%) cases with hypopharyngeal carcinomas. In every case the presence of unilateral metastases in lymphatic nodes of the neck was the reason of radical neck dissection, in bilateral metastases radical neck dissection was applied at one side of the neck and functional neck dissection on the second side.Lymphatic metastases in laryngeal cancer are related to: site of primary tumor, extension of primary tumor and histologic differentiation. The metastases to lymph nodes in cancer of hypopharynx are diagnosed in the greater part, independently from progression of tumor. Presence of metastases in lymphatic nodes influence significantly on estimation of the treatment independently from progression of tumor. It was state that the best results give the method of combined treatment: the surgery and postoperative radiotherapy.
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Hypopharyngeal cancer
Primary tumor
Cervical lymph nodes
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Abstract Background One third of all head and neck cancers are caused by laryngeal cancer. However, the incidence and prevalence rates have decreased over the past 3 decades. Neck metastasis from cancer larynx is important to be addressed as its presence greatly reduces the probability of survival. However, quality of life should be taken into consideration. Hence, it was important to analyze factors related to neck metastasis from primary laryngeal cancer to detect any change of tumor behavior with time. Results One hundred thirty-eight patients underwent concomitant neck dissection with laryngectomy (total or partial). Supraglottic tumors had the greatest share in the neck metastasis with a count of 11 (of 26 neck metastasis), representing 42% and a total value of 11 (of 30 total supraglottic cancer) representing a tendency of spread in 37% of the total case number. Tumor midline crossing was present in 77% cases (20 of 26) with positive nodes, representing a P value 0.05. Conclusion This study investigated different factors related to lymph node metastasis from primary laryngeal tumor. The most important factors were the site of the tumor and its relation to the midline.
Neck dissection
Hypopharyngeal cancer
Concomitant
Primary tumor
Distant metastasis
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Neck dissection
Cervical lymph nodes
Primary tumor
Occult
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Objective To analyze the regional distribution of cervical lymph node metastasis of patients with cN0 tongue carcinoma to made the reference for the selection of neck dissection.Methods Lymph nodes in every level were collected from specimens of radical neck dissection of 61 patients with cN0 tongue carcinoma.The metastasis was checked pathologically and the regional distributions were analyzed.Results Lymph node metastases were found in 20 patients and the metastasis rate was 32.8%.sixty-two lymph nodes were found with metastasis in 811 lymph nodes(7.6%).The metastasis rate was 11.0%(26/237)in levelⅠ,8.2%(20/243)in level Ⅱ,6.0%(13/218)in level Ⅲ,3.5%(3/85)in level Ⅳ,and no lymph node metastasis in level Ⅴ.Conclusion There was a higher metastasis rate in patients with cN0 tongue carcinoma.The metastasis lymph nodes were mainly distributed in level Ⅰ,Ⅱ and Ⅲ and few in level Ⅳ.It is better to extend to level Ⅳ in supraomohyoid neck dissection.
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Large cervical lymph nodes and the extranodal extension of metastatic lymph nodes are considered poor prognostic factors in head and neck squamous cell carcinoma (HNC).The efficacy of intra-arterial chemotherapy (iaCT) targeting lymph node (LN) in HNC was examined.We performed a retrospective review of 41 patients with laryngeal and hypopharyngeal cancer showing metastatic cervical LN larger than 20 mm treated with iaCT with concurrent radiotherapy. The administration of cisplatin into LN was divided into three groups: no administration (NO), via the same artery as that supplying the primary tumor (SAME), and via a different artery from that supplying the primary tumor (DIFFERENT).A trend toward a more favorable three-year regional control in DIFFERENT compared to NO was observed, although the mean size of LN in DIFFERENT was larger than in the other groups. A better regional control was obtained in both DIFFERENT (p < .05) and DIFFERENT + SAME (p < .05) when overall rather than partial enhancement of lymph node by CT angiography was observed. Extranodal extension could be a factor predicting unfavorable regional control.Targeting lymph node may be helpful to avoid neck dissection when iaCT was planned in HNC with relatively large LNs.
Cervical lymph nodes
Neck dissection
Hypopharyngeal cancer
Primary tumor
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Backround/aim: Papillary thyroid carcinomas (PTC) frequently metastasize to regional lymph nodes. We purposed to investigate the predictive role of tumor location for lymph node metastasis pattern in PTCs. Materials and methods: Medical records of 110 PTC patients were reviewed retrospectively. Tumor location was determined as upper, middle and lower pole according to ultrasonography (USG) findings. The effects of age, gender, tumor size and location on lymph node metastasis were investigated. Results: The series comprised 87% females (n:96), and 13% males (n:14). 43 patients had central neck metastasis (CNM), 14 had lateral neck metastasis (LNM). Upper pole tumors (UPT) metastasized to the central neck (CN) at a lower rate (17.6%) than middle (40.0%) or lower (48.5%) poles overall (p:0.104), while it was at a significantly lower rate (13.3%) in the PTC group (p<0.05). UPTs (n:17) metastasized to the lateral neck (LN) at almost 2-fold more. It was observed that 3 of 4 UPTs spread directly to the LN without CNM. Conclusion: In our opinion, UPTs have propensity to demonstrate metastase to LN rather than the CN in PTCs. Therefore, UPTs should be evaluated meticulously in terms of LNM. New studies could suggest that CN dissection is not performed for low risk PTCs in UPTs. Key words: Papillary thyroid cancer, lymph node metastase, tumor location
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A clinicopathological study was made of 23 cases of oral squamous cell carcinoma with secondary metastasis to cervical lymph nodes, and the following findings were obtained.1. Secondary lymph nodes metastasis appeared in 36% of N0 cases.2. Clinical or histological factors (primary site, T-classification, age, treatment methods of primary tumor, degree of differentiation, mode of invasion, etc.) were not very available for the prediction of secondary metastasis.3. The sites of metastasis were level I or level II in most cases.4. The control rate of cervical tumor of secondary metastasis cases treated with radical neck dissection was 84%, which is almost equal to that of first metastasis cases.5. These findings suggest that elective neck dissection is not necessary for oral squamous cell carcinoma.
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