title: Predicting factors for distant metastases in head and neck carcinomas: an analysis of 103 patients with locoregional control.
abstract: OBJECTIVE
  This study evaluated the ability of certain clinical and pathologic parameters to predict distant metastases (DMs) in patients with squamous cell carcinoma of the head and neck.
  
  
  METHODS
  A total of 103 patients with histologically proven squamous cell carcinoma of the head and neck were studied. None had persistent or recurrent disease above the clavicle. Of these patients, 48 (47%) had metastatic lymph nodes. The relationships of tumor stage, primary site, clinical growth pattern, tumor differentiation, regional node status, and extranodal spread (ENS) with DMs were evaluated.
  
  
  RESULTS
  Twenty-one (20%) of the 103 patients developed DMs as the initial treatment failure. The incidence of DMs was significantly higher in patients with neck metastases (40%) than in those without neck metastases (4%) (P < .001). The degree of histologic differentiation and the presence of ENS were also correlated with the subsequent occurrence of DMs. There was no statistical difference in the incidence of DMs based on sex, location, stage of the disease, and clinical growth pattern. On multivariate analysis, only pathologic nodal status and ENS proved to be independent cofactors of DMs. The most common site of DMs was the lungs (56%), followed by bone (16%) and skin (16%).
  
  
  CONCLUSIONS
  The presence of pathologically positive nodes is the most critical factor to influence the eventual development of DMs.
authors.affiliation: First Department of Oral and Maxillofacial Surgery, School of Dentistry, Niigata University, Gokkocho, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Shingaki
authors.forename: I
authors.initials: I
authors.lastname: Suzuki
authors.forename: T
authors.initials: T
authors.lastname: Kobayashi
authors.forename: T
authors.initials: T
authors.lastname: Nakajima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis