title: Bilateral neck metastases in upper aero-digestive tract cancer: emphasis on the distribution of lymphatic metastases and prognostic implications.
abstract: BACKGROUND
  Bilateral neck metastases (BNM) in patients with upper aero-digestive tract cancer (UADTC) indicate a poor prognosis. However, the prognostic significance of involved neck node levels has not been determined clearly. In this study, the distribution of neck nodal metastasis and its impact on prognosis were investigated.
  
  
  METHODS
  Eighty-two previously untreated UADTC patients with BNM from 2000 to 2007 were included in these analyses. The pathology was mainly squamous cell carcinomas, including nasopharynx undifferentiated carcinoma and excluding salivary and thyroid carcinomas. The distribution and pattern of neck metastases and their prognostic significance were assessed, along with other clinical variables.
  
  
  RESULTS
  BNM confined to the upper neck level (I-III) showed a lower rate of distant metastasis compared to BNM beyond I-III levels (13.6% vs. 47.4%, P = 0.001). There was a significant reduction in survival among patients with bilateral lower neck (IV-V) metastases on multivariate analysis (HR: 5.95, 95%CI: 1.51-23.43). However, multi-level involvement itself did not correlate with survival. Subgroup analysis (according to nasopharynx and non-nasopharynx cancer) also confirmed the strong trends of lower neck nodal involvement for poorer survival in both groups.
  
  
  CONCLUSIONS
  BNM at lower neck nodes can be a significant prognostic factor for early systemic dissemination and worse prognosis in UADTC patients.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Tae Wook
authors.initials: TW
authors.lastname: Kim
authors.forename: Man Ki
authors.initials: MK
authors.lastname: Chung
authors.forename: Hye-Youn
authors.initials: HY
authors.lastname: Youm
authors.forename: Jong-In
authors.initials: JI
authors.lastname: Jeong
authors.forename: Young-Ik
authors.initials: YI
authors.lastname: Son
authors.forename: Han-Sin
authors.initials: HS
authors.lastname: Jeong
authors.forename: Chung-Hwan
authors.initials: CH
authors.lastname: Baek
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D011379:Prognosis; D016016:Proportional Hazards Models