title: Extent of extracapsular spread: a critical prognosticator in oral tongue cancer.
abstract: BACKGROUND
  Extracapsular spread (ECS) of metastatic squamous cell carcinoma of the head and neck to regional lymph nodes is the most reliable predictor of poor treatment outcomes. Recently, the authors have shown that ECS is significantly associated with higher rates of locoregional recurrence, distant metastasis, and decreased survival in patients with squamous cell carcinoma of the oral tongue (SCCOT). The purpose of this review was to determine if the degree of ECS impacts distant metastasis rates and survival.
  
  
  METHODS
  Two hundred sixty-six patients treated for SCCOT with surgery +/- adjuvant radiotherapy from 1980-1995 were reviewed. The setting was a tertiary referral center. The extent of ECS on histopathologic review of involved lymph nodes was measured from the capsular margin to the farthest perinodal extension in mm. Extent of ECS and the number of pathologic lymph nodes with or without ECS were analyzed for disease-free interval, survival rates, and distant metastases.
  
  
  RESULTS
  No differences in the survival of patients with ECS of </= 2 mm or > 2 mm was found (P = 0.92). Patients with both ECS and multiple positive lymph nodes had decreased overall survival (P = 0.0003), disease-specific survival (P = 0.0005), and a shorter disease-free interval (P = 0.019) when compared with those with a single positive lymph node with ECS. Those with multiple ECS+ lymph nodes had the worst prognosis (P = 0.001).
  
  
  CONCLUSIONS
  Based on these findings, the authors recommended that all patients with SCCOT with ECS or multiple positive lymph nodes with or without ECS on pathologic review be considered for clinical trials that intensify regional and systemic adjuvant therapy.
authors.affiliation: The Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: Jayson S
authors.initials: JS
authors.lastname: Greenberg
authors.forename: Robert
authors.initials: R
authors.lastname: Fowler
authors.forename: Jose
authors.initials: J
authors.lastname: Gomez
authors.forename: Vivian
authors.initials: V
authors.lastname: Mo
authors.forename: Dianna
authors.initials: D
authors.lastname: Roberts
authors.forename: Adel K
authors.initials: AK
authors.lastname: El Naggar
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Myers
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013534:Survival; D014062:Tongue Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery