title: Extensive neck node metastases (N3) in head and neck squamous carcinoma: is radical treatment warranted?
abstract: OBJECTIVE
  Head and neck squamous cell carcinoma (HNSCC) patients with N3 neck disease at presentation are the minority. Prognosis for such patients is poor, but there is disagreement about which treatment policy is best adopted. The aim of this study was to identify which groups of patients are best offered radical treatment, examining factors of association, prognosis, and survival.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Regional tertiary head and neck cancer unit.
  
  
  METHODS
  Data were collected prospectively from patients treated for HNSCC with N3 nodal disease between 1975 and 2005. The data collected included age, sex, tumor TNM stage, histological grade, treatment, and survival. Odds ratio was used to calculate whether each parameter was statistically significant. Tumor-specific and observed survival curves were also calculated.
  
  
  RESULTS
  A total of 275 patients had N3 disease. Multivariate analysis confirmed that advanced disease at the primary site (odds ratio = 4.6, P = .0261) mitigated against curative treatment. Comparison of tumor-specific survival between curative and palliative treatment strategies suggests that aggressive treatment is associated with greatly improved survival (median survival = 1.45 years, 95% confidence interval [CI] = 1.23-1.67 years; 5-year survival = 26.6%, CI = 17.14%-36.06%) compared with those treated palliatively (median survival = 3.18 months, CI = 3.06-3.30 months; no 5-year survivors; P < .0001).
  
  
  CONCLUSIONS
  A major factor in determining treatment strategies for N3 disease HNSCC is the extent of disease at the primary site. These data suggest that aggressive treatment of the neck improves survival and should be considered in these patients.
authors.affiliation: University of Liverpool, School of Cancer Studies, Department of Surgery and Oncology, Liverpool, UK.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Jones
authors.forename: Paul W
authors.initials: PW
authors.lastname: Goodyear
authors.forename: Samit
authors.initials: S
authors.lastname: Ghosh
authors.forename: David
authors.initials: D
authors.lastname: Husband
authors.forename: Tim R
authors.initials: TR
authors.lastname: Helliwell
authors.forename: Terry M
authors.initials: TM
authors.lastname: Jones
mesh_terms: D002277:Carcinoma / Q000401:mortality / Q000556:secondary / Q000628:therapy; D002294:Carcinoma, Squamous Cell; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D006801:Humans; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D018307:Neoplasms, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy; D011446:Prospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology