Frequency and Patterns of nodal metastasis in supraglottic squamous cell carcinoma

Choi, Eun Chang; Koh, Yoon Woo; Park, Heon Yee; Kim, Sang Yeop; Kim, Chang Woo; Kim, Jin Young; Kim, Kwang Moon

Abstract

BACKGROUND AND OBJECTIVES: Supraglottic larynx is a well-known primary site of the head and neck cancer with frequent nodal metastasis, but pathologically confirmed data is lacking in our country.
PATIENTS AND METHODS
Pathologic reports of supraglottic squamous cell carcinoma were reviewed using the records of 73 patients who underwent surgery as an initial treatment at Severance Hospital between April 1992 and December 1999. Fifty-three patients had simultaneous bilateral neck dissection, while 13 had unilateral neck dissection. The average number of nodes investigated was 46.5 +/- 14.0 for the comprehensive neck dissection specimen and 29.4 +/- 10.9 for he lateral neck dissection.
RESULTS
Seventy-one percent of the patients had patholigically proven nodal metastasis at the time of diagnosis. Ninty-percent (47/52) of patients with pathologically proven metastasis had multiple lymph node metastasis. Nodal metastasis rate according to T stages was as follows ; T1 57.1% (4/7), T2 72.0% (18/25), T3 76.0% (19/25), T4 68.8% (11/16) respectively. Metastasis rate according to subsite was as follows ; 79.3% for epiglottis, 56.5% for false cord, 76.2% for aryepiglottic fold respectively. Ipsilateral and contralateral occult metastasis rate were 28.6% (8/28) and 14.3% (4/28), respectively. The percentage of contralateral occult metastasis for clinically ipsilateral node positive patient was 27.8% (10/36). 40.4% (19/47) of the patients with tumor which involved the midline had contralateral metastasis while 11.5% (3/26) for the patients with tumor were confined to one side.
CONCLUSION
Patients with supraglottic squamous cell carcinoma need aggressive treatment of neck, because nodal metastasis is very frequent at the time of diagnosis. Elective treatment of contralateral neck may be needed for ipsilateral node positive patients. Patients who were clinically proven NO also need to take elective treatments at least for the ipsilateral side.