Distant metastases from squamous-cell carcinomas of the upper aerodigestive tract. The influence of clinical tumor parameters and the course of the disease

Screening for distant metastases from head and neck tumors is still controv ersial. In the present study, the records of 1087 patients with newly diagn osed squamous cell carcinomas of the upper aerodigestive tract were reviewe d retrospectively to determine clinical factors influencing the incidence a nd location of distant metastases. Overall, 130 patients (12.0%) developed clinical evidence of metastatic disease, 17 of whom (1.6%) had metastases a t the time of initial presentation. The rate of distant metastases signific antly increased with the initial stage of tumors (P<0.00001) and the occurr ence of local and/or regional recurrences (P<0.00001) or of second primarie s below the clavicles (P<0.0005). The locations of primary cancers as well as histopathologic grading were not independent risk factors for the develo pment of distant metastases. They mainly reflected different frequency dist ributions of stages. The lungs, liver and bones were the most common sites of metastatic disease, being involved in 68.5%, 23.8% and 20.0% of cases, r espectively Our findings show that at the time of initial presentation ches t X-ray alone appears to be sufficient to exclude distant metastases from t umors classified as T1-3 N0. Further screening comprising abdominal ultraso und, bone scanning and/or CT scans of the thorax is particularly indicated for patients with advanced-stage disease, local and/or regional recurrences and second primaries below the clavicles. However, the individual decision s should consider whether the detection of distant metastases will signific antly affect clinical management.