title: Prognostic impact of the level of neck metastasis in oral cancer patients.
abstract: Neck staging in oral cancer depends on the number of compromised nodes, their size and side of occurrence.
  
  
  OBJECTIVE
  This paper aims to evaluate risk factors for metastatic nodes in levels IV/V and their prognostic impact on patients with oral carcinoma.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  pathologist's diagnosis of squamous cell carcinoma, primary tumor in the lower oral cavity, no extension into extraoral sites, no previous treatment, synchronous neck dissection and presence of metastatic nodes. Risk factors for metastasis were evaluated through logistic regression and disease-specific survival and recurrence by survival analysis. Classificatory analysis was performed through recursive partitioning.
  
  
  RESULTS
  307 patients met the inclusion criteria. Univariate logistic regression identified pN stage, vascular invasion, and multiple metastatic nodes as risk factors for metastases in levels IV/V. Multivariate analysis found vascular invasion and multiple metastatic nodes were significant. Survival analysis revealed pT, pN, neural infiltration, vascular invasion, number of metastatic nodes, metastases in levels IV/V, and node ratio were significant factors. In multivariate survival analysis, pT, pN, vascular invasion and metastases in levels IV/V were significant. Classificatory analysis showed that pN is non-significant in patients with level IV/V metastases.
  
  
  CONCLUSIONS
  The occurrence of metastases in levels IV/V was significant for disease-specific survival.
authors.affiliation: Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, Hospital A. C. Camargo, Rua Professor Antonio Prudente no. 211. Liberdade, São Paulo, SP, Brazil. hkohler75@gmail.com
authors.forename: Hugo Fontan
authors.initials: HF
authors.lastname: Köhler
authors.forename: Luiz Paulo
authors.initials: LP
authors.lastname: Kowalski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary*; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000556:secondary*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality / Q000473:pathology*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D047368:Tumor Burden; D055815:Young Adult