title: Clinical nodal stage is an independently significant predictor of distant failure in patients with squamous cell carcinoma of the larynx.
abstract: OBJECTIVE
  To determine the impact of clinical nodal stage on distant metastasis (DM) in patients with squamous cell carcinoma of the larynx (SCCL).
  
  
  METHODS
  Six hundred sixty-two previously untreated SCCL patients treated at a tertiary care cancer center from January 1984 to December 1998 were eligible for analysis. The end point of interest was development of DM following treatment. Distant metastasis-free survival (DMFS) was calculated by the Kaplan-Meier method; predictors of outcome were identified by univariate and multivariate analysis. The primary tumor site was glottic in 55%, supraglottic in 40%, and trans/sub glottic in 5%; 40% had locoregionally advanced (stage III/IV) tumors. At initial presentation, 25% of patients (12% N1, 11% N2, and 2% N3) had clinically metastatic nodes.
  
  
  RESULTS
  DM were recorded in 67 patients (10%; lung, 45%; soft tissue, 13%; bone, 10%; multiple sites, 28%). The median time to DM was 18 months (range, 1-109). With a median follow-up of 60 months, the 5-year DMFS was 88%. Even after accounting for the type of index treatment, the only significant predictor of worse DMFS on multivariate analysis was a higher clinical N stage (P < 0.0001). The relative risk for DM was 0.5 (95% CI, 0.2-1.4; P = NS) for cN1, 3.2 (95% CI, 1.7-5.9; P < 0.0001) for cN2, and 7.5 (95% CI, 3.1-17.9; P < 0.0001) for cN3 disease compared with clinically N0 patients.
  
  
  CONCLUSIONS
  Regardless of the index treatment modality, primary tumor site, or T stage, a higher clinical N stage at the time of presentation independently and significantly increases the risk of DM in patients with SCCL.
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D003131:Combined Modality Therapy; D016208:Databases, Factual / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis / Q000473:pathology; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology* / Q000628:therapy; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018570:Risk Assessment; D013997:Time Factors