PRIMARY HEAD AND NECK-CANCER - HISTOPATHOLOGIC PREDICTORS OF RECURRENCE AFTER NECK DISSECTION IN PATIENTS WITH LYMPH-NODE INVOLVEMENT

Objective: Retrospectively analyze several histopathologic variables t hat may predict neck recurrence after neck dissection. Design: From 19 70 through 1980, 284 patients with pathologically confirmed metastatic squamous cell carcinoma underwent neck dissection and received no adj uvant therapy. Kaplan-Meier evaluation estimated a 74% 2-year neck rec urrence-free rate. After adjusting for the standard covariates of age, gender, neck stage, and tumor grade, we also controlled for the time- dependent covariates of primary recurrence, occurrence in the side of the neck not operated on, or development of new head and neck primary disease. Setting: A large referral-based practice. Results: The number of lymph nodes involved, invasion of vascular/lymphatic space, invasi on of soft tissue, and desmoplastic lymph node pattern adversely affec t neck recurrence. A desmoplastic stromal pattern was associated with almost a sevenfold increased risk of neck recurrence. To our knowledge , this finding has not been reported previously. Conclusion: Histopath ologic evaluation of metastatically involved cervical nodes can identi fy patients with head and neck cancer who are at high risk for recurre nce.