PREDICTING FACTORS FOR DISTANT METASTASES IN HEAD AND NECK CARCINOMAS- AN ANALYSIS OF 103 PATIENTS WITH LOCOREGIONAL CONTROL

Purpose: This study evaluated the ability of certain clinical and path ologic parameters to predict distant metastases (DMs) in patients with squamous cell carcinoma of the head and neck. Materials and Methods: A total of 103 patients with histologically proven squamous cell carci noma of the head and neck were studied. None had persistent or recurre nt disease above the clavicle. Of these patients, 48 (47%) had metasta tic lymph nodes. The relationships of tumor stage, primary site, clini cal growth pattern, tumor differentiation, regional node status, and e xtranodal spread (ENS) with DMs were evaluated. Results: Twenty-one (2 0%) of the 103 patients developed DMs as the initial treatment failure . The incidence of DMs was significantly higher in patients with neck metastases (40%) than in those without neck metastases (4%) (P <.001). The degree of histologic differentiation and the presence of ENS were also correlated with the subsequent occurrence of DMs. There was no s tatistical difference in the incidence of DMs based on sex, location, stage of the disease, and clinical growth pattern. On multivariate ana lysis, only pathologic nodal status and ENS proved to be independent c ofactors of DMs. The most common site of DMs was the lungs (56%), foll owed by bone (16%) and skin (16%). Conclusion: The presence of patholo gically positive nodes is the most critical factor to influence the ev entual development of DMs.