title: Inclusion of extracapsular spread in the pTNM classification system: a proposal for patients with head and neck carcinoma.
abstract: OBJECTIVE
  The inclusion of data about the presence of metastatic neck nodes with extracapsular spread (ECS) in the neck dissection improves the prognostic classification of patients with head and neck squamous cell carcinoma (HNSCC).
  
  
  OBJECTIVE
  To evaluate the prognostic capacity of ECS in patients with HNSCC, and to analyze the usefulness of including this information in the pathological classification of patients treated with a neck dissection.
  
  
  METHODS
  Retrospective unicenter study performed from 1985 through 2007.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  A total of 1190 patients with HNSCC treated with a neck dissection.
  
  
  METHODS
  Unilateral or bilateral neck dissection .
  
  
  METHODS
  Adjusted survival and local, regional, and distant metastases-free survival. Patients were classified according to a recursive partitioning analysis (RPA) method, considering pN category and number of neck nodes with ECS as the independent variables.
  
  
  RESULTS
  Five-year adjusted survival for patients without metastatic nodes in the neck dissection (pN0) was 85.5%, for patients with neck node metastases without ECS (pN+/ECS-) it was 62.5%, and for patients with neck node metastases with ECS (pN+/ECS+) it was 29.9%. There were significant differences in survival between patients with pN0 lesions and pN+/ECS- (P < .001), and between patients with pN+/ECS- and those with pN+/ECS+ (P < .001). According to the RPA method, we propose classifying patients according to 4 categories: category I, pN0 lesions; category II, pN1/ECS+ or pN+/ECS-; category III, pN2-3/1 node and ECS+; and category IV, pN2-3/2 or more nodes and ECS+. The RPA-derived classification achieved a better prognostic discrimination than the pTNM classification.
  
  
  CONCLUSIONS
  The inclusion of information about ECS in the neck dissection improved the prognostic classification of patients with HNSCC in relation to the pTNM classification.
authors.affiliation: Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: de Juan
authors.forename: Jacinto
authors.initials: J
authors.lastname: García
authors.forename: Montserrat
authors.initials: M
authors.lastname: López
authors.forename: César
authors.initials: C
authors.lastname: Orús
authors.forename: Eduard
authors.initials: E
authors.lastname: Esteller
authors.forename: Miquel
authors.initials: M
authors.lastname: Quer
authors.forename: Xavier
authors.initials: X
authors.lastname: León
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000628:therapy*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D037981:Neck Dissection / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging / Q000145:classification*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013030:Spain; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome