title: Regional lymph node involvement and its significance in the development of distant metastases in head and neck carcinoma.
abstract: BACKGROUND
  The incidence of distant metastases in head and neck cancer patients is rising because of greater locoregional control of the disease.
  
  
  METHODS
  The relative risks for having distant metastases as first site of failure relative to the regional lymph node involvement were determined.
  
  
  RESULTS
  The overall incidence was 10.7%, with a clear relationship between the number of involved lymph nodes and extranodal spread on one hand, and distant spread on the other hand. The group with histopathologic presence of disease in the neck had twice as much distant metastases as did those with histopathologic absence (13.6% versus 6.9%). Patients with more than three histologically positive lymph nodes were most at risk for having distant metastases (46.8%). The presence of extranodal spread meant a threefold increase in the incidence of distant metastases, compared with patients without this feature (19.1% versus 6.7%).
  
  
  CONCLUSIONS
  Patients with three or more positive nodes and with extranodal spread may benefit from adjuvant systemic therapy.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Free University Hospital, Amsterdam, The Netherlands.
authors.forename: C R
authors.initials: CR
authors.lastname: Leemans
authors.forename: R
authors.initials: R
authors.lastname: Tiwari
authors.forename: J J
authors.initials: JJ
authors.lastname: Nauta
authors.forename: I
authors.initials: I
authors.lastname: van der Waal
authors.forename: G B
authors.initials: GB
authors.lastname: Snow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis