title: Patterns and treatment of neck metastases in patients with salivary gland cancers.
abstract: BACKGROUND
  Management of the neck in patients with salivary gland cancer is controversial. This study aimed to identify clinicopathologic characteristics associated with regional metastases and regional recurrence in patients with salivary gland carcinoma.
  
  
  METHODS
  Of 363 study patients, 51 underwent therapeutic neck dissection (TND) and 312 underwent either elective neck dissection (END, n = 110) or no neck dissection (NoND, n = 202). Univariate and multivariate analyses were performed to identify clinicopathologic characteristics associated with regional metastases and recurrence.
  
  
  RESULTS
  Pathologic neck metastases were identified in 17/110 (15.5%) END patients and neck recurrence was identified in 5/202 (2.5%) NoND patients. Histologic grade (P < 0.001), tumor site (P = 0.008), and lymphovascular invasion (P < 0.001) were independent risk factors for neck metastases. Nodal metastases were more common in high-grade tumors (P < 0.001), at levels I-III in END patients and levels I-V in TND patients. Multivariate analyses identified histologic grade (P = 0.020), clinical N2 classification (P = 0.007), and extranodal extension (P = 0.005) as independent factors for regional recurrence after treatment.
  
  
  CONCLUSIONS
  Patients with high-grade cancers should receive END involving levels I-III, whereas patients with node-positive salivary cancers should receive comprehensive TND involving all levels (I-V).
authors.affiliation: Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Shin-Hyuk
authors.initials: SH
authors.lastname: Yoo
authors.affiliation: Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Jong-Lyel
authors.initials: JL
authors.lastname: Roh
authors.affiliation: Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Seon-Ok
authors.initials: SO
authors.lastname: Kim
authors.affiliation: Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyung-Ja
authors.initials: KJ
authors.lastname: Cho
authors.affiliation: Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Soon Yuhl
authors.initials: SY
authors.lastname: Nam
authors.affiliation: Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.|Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, Republic of Korea.
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000556:secondary / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D012468:Salivary Gland Neoplasms / Q000473:pathology*; D016019:Survival Analysis; D055815:Young Adult
keywords: metastasis; neck dissection; neck recurrence; pattern; salivary gland cancers