Survival and patterns of recurrence in 200 oral cancer patients treated byradical surgery and neck dissection

The outcome of 200 patients with squamous cell carcinoma of the oral/oropha ryngeal mucosa managed by primary radical surgery and simultaneous neck dis section and followed for 2.2-8.5 years is reported and related to the patho logical features. Ninety-nine patients (50%) had cervical lymph node metast ases including 16 (8%) with bilateral metastases. Actuarial (life tables) s urvival analysis showed the overall 2-year survival probability was 72%, fa lling to 64% at 5 years. The 5-year survival probability was 81% for patien ts without metastasis, 64% for patients with intranodal metastases and 21% for patients with metastases showing extracapsular spread. A total of 60 pa tients (30%) died of/with their cancer: 36 (18%) of local recurrence; 4 (2% ) of a metachronous primary tumour; 14 (7%) of regional disease, and 6 (3%) with systemic metastases. A further 15 patients (8%) had relapsed but were clinically disease-free after additional surgery. In all, 7% of the series developed metachronous primary tumours. In addition to nodal metastasis, s urvival was related to the site and stage of the primary tumour, the histol ogical grade and pattern of invasion, status of the resection margins and p athological TNM stage. For patients with lymph node metastasis, extracapsul ar spread was an important indicator of tumour behaviour and we recommend i ts use as a criterion for pathological N staging. (C) 1999 Elsevier Science Ltd. All rights reserved.