Impact of lymph node metastasis on the pattern of failure and survival in oral carcinomas

BACKGROUND: Carcinomas of the oral cavity present a high risk for neck metastases that decrease the disease control and survival. METHODS: A total of 106 patients with squamous cell carcinoma of the oral cavity who had metastatic neck nodes were studied. The impact of neck metastasis and treatment modalities on outcome was assessed. RESULTS: Thirty-eight patients developed neck recurrence or distant metastasis. The 5-year survival, neck recurrence-free, and distant metastases-free rates were 56%, 84%, and 77%, respectively. Univariate analyses showed extranodal spread (ENS), number of positive nodes, and adjuvant chemotherapy were predictors for survival. In multivariate analysis, ENS and postoperative radiotherapy were of borderline significance. There was no prognostic factor for neck control. The presence of ENS and lower levels of positive nodes and no chemotherapy were associated with high distant failure rates. CONCLUSIONS: To prevent distant metastases, patients with ENS should be considered for adjuvant chemotherapy.