title: Extracapsular spread in oral squamous cell carcinoma.
abstract: BACKGROUND
  Extracapsular spread (ECS) in the cervical lymph nodes represents the most significant adverse prognostic indicator in oral squamous cell carcinoma (OSCC).
  
  
  METHODS
  In a consecutive cohort of OSCC treated by primary surgery, ECS was seen in 25% (101) of 400 patients.
  
  
  RESULTS
  ECS doubled the incidence of local recurrence and distant metastases, but tripled regional failure. The recurrences occurred sooner in ECS than in non-ECS cases (206 vs 334 days, p = .04). Patients with macroscopic ECS had a 5-year overall survival (OS) of 19% compared with 31% in microscopic ECS. MRI neck staging offered poor sensitivity, especially in microscopic ECS. Age >75 years, smoking, and heavy use of alcohol were independent predictors of ECS, which may implicate a failure of immunosurveillance by the host as much as adverse biology of the tumor.
  
  
  CONCLUSIONS
  Reporting of ECS is essential in accurate prognostication, and we advocate that all patients with OSCC and ECS should be grouped as pN3 on the basis of their prognosis. (c) 2009 Wiley Periodicals, Inc. Head Neck, 2010.
authors.affiliation: Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, United Kingdom. richard.shaw@liv.ac.uk
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Shaw
authors.forename: Derek
authors.initials: D
authors.lastname: Lowe
authors.forename: Julia A
authors.initials: JA
authors.lastname: Woolgar
authors.forename: James S
authors.initials: JS
authors.lastname: Brown
authors.forename: E David
authors.initials: ED
authors.lastname: Vaughan
authors.forename: Christopher
authors.initials: C
authors.lastname: Evans
authors.forename: Huw
authors.initials: H
authors.lastname: Lewis-Jones
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hanlon
authors.forename: Gillian L
authors.initials: GL
authors.lastname: Hall
authors.forename: Simon N
authors.initials: SN
authors.lastname: Rogers
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D009062:Mouth Neoplasms / Q000401:mortality / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors