Bilateral neck metastases in upper aero-digestive tract cancer: Emphasis on the distribution of lymphatic metastases and prognostic implications

Background Bilateral neck metastases (BNM) in patients with upper aero-digestive tract cancer (UADTC) indicate a poor prognosis. However, the prognostic significance of involved neck node levels has not been determined clearly. In this study, the distribution of neck nodal metastasis and its impact on prognosis were investigated. Methods: Eighty-two previously untreated UADTC patients with BNM from 2000 to 2007 were included in these analyses. The pathology was mainly squamous cell carcinomas, including nasopharynx undifferentiated carcinoma and excluding salivary and thyroid carcinomas. The distribution and pattern of neck metastases and their prognostic significance were assessed, along with other clinical variables. Results: BNM confined to the upper neck level ( I-III) showed a lower rate of distant metastasis compared to BNM beyond I-III levels ( 13.6% vs. 47.4%, P 0.001). There was a significant reduction in survival among patients with bilateral lower neck ( IV-V) metastases on multivariate analysis ( HR: 5.95, 95% CI: 1.51-23.43). However, multi-level involvement itself did not correlate with survival. Subgroup analysis ( according to nasopharynx and non-nasopharynx cancer) also confirmed the strong trends of lower neck nodal involvement for poorer survival in both groups. Conclusion: BNM at lower neck nodes can be a significant prognostic factor for early systemic dissemination and worse prognosis in UADTC patients. J. Surg. Oncol. 2012; 105: 553-558. (C) 2011 Wiley Periodicals, Inc.