title: Prognostic significance of nodal metastasis in advanced tumors of the larynx and hypopharynx.
abstract: OBJECTIVE
  To estimate the relevance of post-surgical neck nodal classification (pN) on the global survival of patients with advanced tumors of the larynx and hypopharynx, primarily treated with surgery including neck dissection (ND). To understand the prognostic significance of metastatic lymph nodes' extracapsular spread (ECS) and its impact on survival.
  
  
  METHODS
  A retrospective review of patients primarily submitted for total laryngectomy (TL) with either elective or therapeutic bilateral ND. Overall and disease-free survival was analysed according to post-operative histopathological ND results, concerning the presence or absence of nodal involvement, number of affected nodes and the existence of ECS.
  
  
  RESULTS
  One hundred and twenty patients met the inclusion criteria of this study. Concerning nodal involvement, the histopathological evaluation demonstrated positive lymph nodes in 46.6% of the cN0 patients. The rate of patients alive after 2 years of follow-up, based on pN analysis, was 88.1% for the pN0 group, 65.4% for the group N+ without ECS, 46.2% for the N+ ECS+ (1 node) and 15.4% for the N+ ECS+ (more than 1 node) group (P<.001).
  
  
  CONCLUSIONS
  This study demonstrates a high prevalence of occult neck disease in tumours of the larynx and hypopharynx. The involvement of metastatic cervical lymph nodes has a negative impact on survival. Patients with multinodal ECS have a poorer survival, reflected by a higher rate of loco-regional and distant metastases, when compared to ECS in one single lymph node.
authors.affiliation: Departamento de Otorrinolaringología, Instituto Oncológico Portugués Francisco Gentil, Oporto, Portugal. ricardobarrosoribeiro@gmail.com
authors.forename: Ricardo
authors.initials: R
authors.lastname: Barroso Ribeiro
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ribeiro Breda
authors.forename: Eurico
authors.initials: E
authors.lastname: Fernandes Monteiro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D007825:Laryngectomy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies
chemical_list: D002945:Cisplatin