title: Predictive value of lymph node metastases and extracapsular extension for the risk of distant metastases in laryngeal carcinoma.
abstract: OBJECTIVE
  The objective of this retrospective chart analysis was to determine the prognostic value of the lymph node status and extracapsular lymph node extension (ECE) of the neck for the development of distant metastases in squamous cell carcinoma of the larynx.
  
  
  METHODS
  One hundred sixty-five patients treated for laryngeal carcinoma with a neck dissection with histologic evaluation were included. Primary study end point was distant metastasis-free survival. Univariate analysis with the Kaplan-Meier method was used to calculate distant metastasis-free survival and overall survival for the whole group and for groups according to ECE/lymph node status. Patients were classified as 1) no metastatic lymph nodes, 2) metastatic lymph nodes without ECE, or 3) metastatic lymph nodes with ECE. Univariate Cox regression was performed with outcome distant metastasis-free survival.
  
  
  RESULTS
  The median overall survival for the whole group was 5.1 years and the 5-year survival rate was 51%. The median distant metastasis-free survival for the whole group could not be calculated and the 5-year metastasis-free survival rate was 78%. The hazard ratio was 3.4 (95% confidence interval [CI] = 1.0-12.1) for patients with positive nodes and without ECE and 10.5 (95% CI = 3.6-30.8) for the patients with metastatic nodes and with ECE compared with the patients without metastatic lymph nodes.
  
  
  CONCLUSIONS
  The presence of ECE in metastatic lymph nodes augments the risk of distant metastasis by nine times in laryngeal carcinoma. Metastatic lymph nodes without ECE show a risk three times greater.
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, Maastricht, The Netherlands.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Oosterkamp
authors.forename: Jos M A
authors.initials: JM
authors.lastname: de Jong
authors.forename: Piet L
authors.initials: PL
authors.lastname: Van den Ende
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Manni
authors.forename: Cary
authors.initials: C
authors.lastname: Dehing-Oberije
authors.forename: Bernd
authors.initials: B
authors.lastname: Kremer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis