OCCULT NODE METASTASES IN HEAD AND NECK SQUAMOUS CARCINOMA

The present study examined the Liverpool database in an attempt to det ermine what proportion of NO necks for various head and neck primary s ites harbored subclinical squamous cell carcinoma and whether empiric treatment of occult disease improved survival over and above a ''wait- and-watch policy'' (treatment when metastasis becomes manifest). One h undred seventeen neck dissections were carried out for NO necks, with 32% of specimens found to contain squamous cell carcinoma. The risk of carcinoma was highest in the hypopharynx, with 50% of specimens assoc iated with a pyriform fossa primary cancer. Twenty-nine percent of nec k dissection specimens for oral cavity cancer contained carcinoma and this was commonly associated with lateral border of tongue or anterior floor of mouth carcinomas. Twenty-five percent of specimens when prim ary tumor was in the oropharynx contained carcinoma and were due to to nsillar carcinoma. Twenty-one percent of laryngeal cancers produced hi stologically positive nodes and were mostly associated with posterior epiglottic tumors. Two hundred forty-six patients had a pyriform fossa cancer and of these only 37 had NO disease and surgical treatment. Of these, 23 patients had radical neck dissections, whereas in 14 the ne cks were not treated. There was no difference in survival between the two groups (chi(1)(2) = 0.787, P = NS). The Liverpool database also co ntained 1631 previously untreated patients with no clinical evidence o f neck node metastases. Of these only 107 had a neck dissection. There was no difference in survival (chi(1)(2) = 2.79, P = NS). When these data were analyzed by multivariate methods (Cox's proportional hazards model) prophylactic neck dissection was found to have no significant effect.