Effect of Cervical Lymph Node Metastasis on Prognosis and it's Risk Factors in Parotid Carcinomas

Lim, Young Chang; Shin, Joong Wook; Baek, Seung Jae; Shin, Yoo Seop; Choi, Eun Chang; Park, Cheong Soo; Kim, Jae Won

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.