title: Patterns of lymph node metastasis and their influence on outcomes in patients with submandibular gland carcinoma.
abstract: OBJECTIVE
  Little is known about lymph node metastasis and the extent of neck dissection (ND) in patients with submandibular gland (SMG) carcinoma. We therefore evaluated the metastatic topography of neck lymph nodes in patients with SMG carcinoma and the influence of metastases on tumor recurrence and patient survival.
  
  
  METHODS
  The pattern of lymph node spread was analyzed in 64 patients with SMG carcinoma treated from January 1994 to January 2009. Disease-free survival (DFS), overall survival (OS), and distant metastasis-free survival (DMFS) were calculated, and the clinicopathological factors associated with each were analyzed.
  
  
  RESULTS
  Positive pathological lymph nodes were detected in 31 (48.4%) patients and was found to correlate significantly with histologic grade (P<0.001) on univariate analysis. Eight patients (19.5%) had occult cervical metastases. The 5-year DFS, OS, and DMFS rates were 46.8, 56.2, and 58.5%, respectively, and 23 patients (35.9%) experienced systemic failure. Multivariate analyses revealed that T-classification (P=0.043) and N-classification (P=0.006) were significantly independent predictors of DFS, whereas only N-classification (P=0.049) was significantly associated with DMFS.
  
  
  CONCLUSIONS
  Elective ND should be recommended for preoperatively suspected high-grade malignancy in SMG carcinoma. Patients with nodal metastasis should receive more effective therapy to hinder recurrence and distant metastasis.
authors.affiliation: Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Myung Woul
authors.initials: MW
authors.lastname: Han
authors.forename: Kyung-Ja
authors.initials: KJ
authors.lastname: Cho
authors.forename: Jong-Lyel
authors.initials: JL
authors.lastname: Roh
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Soon Yuhl
authors.initials: SY
authors.lastname: Nam
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D013365:Submandibular Gland Neoplasms / Q000401:mortality / Q000473:pathology*