title: Cervical lymph node metastasis in oral cancer: the importance of even microscopic extracapsular spread.
abstract: The prognostic significance of extracapsular spread of cervical metastases in oral cancer is still controversial. To investigate the importance of extent of extracapsular spread; the relationship between extracapsular spread and both traditional measures of metastatic disease and clinical/histological features of the primary tumour, and to determine their relative prognostic significance. The survival of 173 patients undergoing radical surgery and simultaneous neck dissection for oral/oropharyngeal squamous cell carcinoma with histologically confirmed nodal metastasis and followed for 2.2-12.3 years is reported and related to pathological features. The most predictive clinical/histopathological features were determined by Cox regression modelling. The 3-year survival probability was similar for patients with macroscopic and only microscopic extracapsular spread (33 and 36%, respectively, compared with 72% for patients with intranodal metastasis). The Cox model showed the most predictive factor was extracapsular spread followed by status of resection margins. Extracapsular spread should be incorporated into pathological staging systems. Even microscopic extracapsular spread is of critical importance and must be sought especially in small-volume metastatic disease.
authors.affiliation: Oral Pathology Laboratory, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS, UK. jaw@liverpool.ac.uk
authors.forename: J A
authors.initials: JA
authors.lastname: Woolgar
authors.forename: S N
authors.initials: SN
authors.lastname: Rogers
authors.forename: D
authors.initials: D
authors.lastname: Lowe
authors.forename: J S
authors.initials: JS
authors.lastname: Brown
authors.forename: E D
authors.initials: ED
authors.lastname: Vaughan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology* / Q000601:surgery; D009333:Neck; D037981:Neck Dissection; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate; D016896:Treatment Outcome