Effect of Cervical Lymph Node Metastasis on Prognosis and it's Risk Factors in Parotid Carcinomas.
- Author:
Young Chang LIM
1
;
Joong Wook SHIN
;
Seung Jae BAEK
;
Yoo Seop SHIN
;
Eun Chang CHOI
;
Cheong Soo PARK
;
Jae Won KIM
Author Information
1. Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea. eunchangmd@yumc.yonsei.ac.kr
- Publication Type:Original Article
- Keywords:
Parotid cancer;
Lymphatic metastasis;
Survival;
Neck dissection
- MeSH:
Facial Nerve;
Facial Paralysis;
Humans;
Logistic Models;
Lymph Nodes*;
Lymphatic Metastasis;
Multivariate Analysis;
Neck;
Neck Dissection;
Neoplasm Metastasis*;
Paralysis;
Parotid Gland;
Parotid Neoplasms;
Prognosis*;
Retrospective Studies;
Risk Factors*
- From:Korean Journal of Otolaryngology - Head and Neck Surgery
2003;46(10):856-861
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND AND OBJECTIVES: Management of the clinically negative neck remains a controvertial issue in patients with carcinoma of the parotid gland. In order to assist in selecting appropriate patients of elective neck dissection, we sought to determine how regional nodal metastasis affects survival in patients with parotid carcinomas and to identify clinical predictors for nodal disease. MATERIALS AND METHOD: We retrospectively evaluated 124 patients with parotid carcinoma who received their definitive treatment at the Severance hospital between 1988 and 2003. A total of 84 neck dissections (ND) were performed. 24 of 84 patients who underwent neck dissection had pN(+)-staged stage. Seventy patients had an elective ND (subdigastric ND in 50 and supraomohyoid ND in 20), usually because of ominous histology or high T stage. Kaplan-Meier survival analysis was conducted to compare patients with and without histopathologic evidence of nodal disease. Univariate and multivariate analyses were carried out using logistic regression evaluating the significance of demographic, clinical, and pathological data. RESULTS: Patients with no evidence of nodal disease had significantly improved survival over patients with pathologically positive nodes (p<0.00001). The following variables were significantly associated to the risk of lymph node metastasis by univariate analysis: sex (p=0.0093), facial palsy (p=0.0001), T stage (p=0.0003), tumor location (p=0.01) and histologic type (p=0.0009). By multivariate analysis, only facial palsy had the highest correlation with lymph node metastasis. CONCLUSION: Nodal disease significantly decrease survival in patients with parotid carcinoma. Tumor histopathologic type and facial nerve involvement are the most important predictors of nodal disease. Therefore, even in cN0, we should consider elective neck dissection in parotid carcinomas in case of high-grade malignancy and/or facial nerve paralysis.
