PROGNOSTIC-SIGNIFICANCE OF EXTRANODAL SPR EAD IN METASTATIC SQUAMOUS-CELL CARCINOMA OF THE HEAD AND NECK

In a retrospective study we evaluated the clinical and histological da tas of patients with squamous cell carcinomas of the head and neck to determine the influence of extranodal spread in metastases for the pro gnosis. Lymph nodes were dissected from the neck dissection specimens and investigated histologically with special regard to extranodal spre ad. 308 patients (58%) showed positive lymph nodes and 212 of this pat ients had additionally extranodal spread (70%). Hence, the rate of ext ranodal spread in the whole investigated group (522 patients) was 40%. For the patients with carcinomas of the hypopharynx the rate of extra nodal spread was especially high (70%). Most extranodal spread could b e found at levels 2, 3 and 4. We found a correlation between the appea rance of extranodal spread and increasing T-stage. 5-year survival rat es were greatly different for patients with no metastases (77%) and pa tients with extranodal spread (28%). We discuss the use of the criteri a extranodal spread for the planning of adjuvant chemotherapy.