[Squamous cell carcinomas of the upper aerodigestive tract. Prognostic significance of the capsular rupture and extracapsular spread of lymph node metastases].

The capsular rupture and subsequent extranodal spread of lymph node metastases is of crucial and well established prognostic value in patients with squamous cell carcinomas of the upper aerodigestive tract. Besides the basic histologic definition of the extranodal spread (i.e. contact of the metastasis with perinodal fatty tissue), there is no agreement on the morphologic extent of transcapsular spread. As a measure of improvement, a histologic evaluation differentiating between seven gradual types of metastatic nodal affection was applied. The histologic scheme considers intranodal growth, infiltration of the capsule, the presence of desmoplasia and especially the rupture of the capsule and the subsequent extranodal spread of the metastasis. As extranodal spread is an easily reproducible and reliably significant prognostic criterion, it should be included in the current TNM classification, e.g., by an addition of the index R+ (lymph node metastasis with capsular rupture) or R- (lymph node metastasis without capsular rupture) to the N category.

[1]  S. Shingaki,et al.  The impact of extranodal spread of lymph node metastases in patients with oral cancer. , 1999, International journal of oral and maxillofacial surgery.

[2]  F. Metternich,et al.  The prognostic impact of metastatic pattern of lymph nodes in patients with oral and oropharyngeal squamous cell carcinomas , 2004, European Archives of Oto-Rhino-Laryngology and Head & Neck.

[3]  H. Sancho-garnier,et al.  Nodal metastasis from carcinomas of the oropharynx. , 1979, Otolaryngologic clinics of North America.

[4]  W. Kehrl1,et al.  Ein neues Schema zur Beurteilung des metastatischen Lymphknotenbefalls beim Plattenepithelkarzinom im HNO-Gebiet* , 1998 .

[5]  A. Leonard,et al.  Correlation between prognosis and degree of lymph node involvement in carcinoma of the oral cavity , 1977 .

[6]  K. Maclennan,et al.  Squamous cell carcinoma of the upper aerodigestive tract: The prevalence of microscopic extracapsular spread and soft tissue deposits in the clinically N0 neck , 2002, Head & neck.

[7]  P. Clifford,et al.  The irradiated radical neck dissection in squamous carcinoma: a clinico-pathological study. , 1980, Clinical otolaryngology and allied sciences.

[8]  M. Carvalho.  Quantitative analysis of the extent of extracapsular invasion and its prognostic significance : A prospective study of 170 cases of carcinoma of the larynx and hypopharynx , 1998 .

[9]  A. Hart,et al.  Prognostic factors of neck node metastasis. , 1982, Clinical otolaryngology and allied sciences.

[10]  C. Wittekind,et al.  TNM Klassifikation maligner Tumoren , 1987 .

[11]  I Suzuki,et al.  Evaluation of histopathologic parameters in predicting cervical lymph node metastasis of oral and oropharyngeal carcinomas. , 1988, Oral surgery, oral medicine, and oral pathology.

[12]  W. Graham,et al.  Lymph node metastases in oral carcinoma. A correlation of histopathology with survival. , 1974, Plastic and reconstructive surgery.

[13]  A. Tannapfel,et al.  Prognosefaktoren bei Kopf-Hals-Karzinomen , 2002, HNO.

[14]  E. Myers,et al.  A long‐term assessment of adjuvant chemotherapy on outcome of patients with extracapsular spread of cervical metastases from squamous carcinoma of the head and neck , 1996, Cancer.

[15]  M. Alloisio,et al.  Prognostic significance of lymphatic spread in head and neck carcinomas: therapeutic implications. , 1985, Head & neck surgery.

[16]  H. Sancho-garnier,et al.  Prognostic factors in cervical lymph node metastasis in upper respiratory and digestive tract carcinomas: Study of 1,713 cases during a 15‐year period , 1987, The Laryngoscope.

[17]  J. Johnson,et al.  Surgical treatment of squamous cell carcinoma of the base of tongue , 2001, Head & neck.

[18]  K. Vosteen,et al.  Der Einfluß von Tumorgröße, Lymphknotenbefall und Behandlungsart auf die Prognose des Hypopharynxkarzinoms , 1982 .

[19]  J. Fowler,et al.  The predictive value of tumor classification compared with results of the british institute of radiology fractionation trial in the treatment of laryngopharyngeal carcinoma , 1990, The Laryngoscope.

[20]  R. Spiro,et al.  Cervical node metastasis from epidermoid carcinoma of the oral cavity and oropharynx. A critical assessment of current staging. , 1974, American journal of surgery.

[21]  G. Snow,et al.  Regional lymph node involvement and its significance in the development of distant metastases in head and neck carcinoma , 1993, Cancer.

[22]  J. Myers,et al.  Extent of extracapsular spread , 2003, Cancer.

[23]  A. Beck,et al.  Kapseldurchbrüche zervikaler Lymphknotenmetastasen: Diagnostischer Stellenwert der Magnetresonanztomographie , 2002 .

[24]  V. Schramm,et al.  Extracapsular spread of carcinoma in cervical lymph nodes impact upon survival in patients with carcinoma of the supraglottic larynx , 1985, Cancer.

[25]  V. Schramm,et al.  The extracapsular spread of tumors in cervical node metastasis. , 1981, Archives of otolaryngology.

[26]  C. Toker.  Some observations on the deposition of metastatic carcinoma within cervical lymph nodes , 1963, Cancer.

[27]  H. Zenner,et al.  Mechanismen der Invasion von Karzinomen der Kopf- und Halsregion , 2001, HNO.

[28]  M. Bignardi,et al.  Prognostic determinants in supraglottic carcinoma: Univariate and Cox regression analysis , 1997, Head & neck.

[29]  G. Snow,et al.  Recurrence at the primary site in head and neck cancer and the significance of neck lymph node metastases as a prognostic factor , 1994, Cancer.

[30]  G. Snow,et al.  The efficacy of comprehensive neck dissection with or without postoperative radiotherapy in nodal metastases of squamous cell carcinoma of the upper respiratory and digestive tracts , 1990, The Laryngoscope.

[31]  R. A. Willis.  Epidermoid carcinoma of the head and neck, with special reference to metastasis , 1930 .

[32]  M. Jäckel,et al.  Prognostische Bedeutung der Expression von p53, bcl-2 und bax im Plattenepithelkarzinom des Larynx – Eine multivariate Analyse , 2001, HNO.

[33]  A. Ricci,et al.  Clinical and pathologic prognostic variables in oropharyngeal squamous cell carcinoma. , 1989, American journal of surgery.

[34]  K. Hirabayashi,et al.  Extracapsular spread of squamous cell carcinoma in neck lymph nodes: Prognostic factor of laryngeal cancer , 1991, The Laryngoscope.

[35]  K. Maclennan,et al.  Cervical node metastases in squamous cell carcinoma of the upper aerodigestive tract: The significance of extracapsular spread and soft tissue deposits , 2003, Head & neck.

[36]  K. Soo,et al.  Radical neck dissections for squamous carcinomas: pathological findings and their clinical implications with particular reference to transcapsular spread. , 1987, International journal of radiation oncology, biology, physics.

[37]  O. Beahrs,et al.  Significance of jugular vein invasion by metastatic carcinoma in radical neck dissection , 1973 .

[38]  J. Reisch,et al.  Microvascular invasion in cancer of the oral cavity and oropharynx. , 1987, Archives of otolaryngology--head & neck surgery.

[39]  K. Soo,et al.  Prognostic implications of perineural spread in squamous carcinomas of the head and neck , 1986, The Laryngoscope.

[40]  J. Myers,et al.  Extracapsular spread , 2001, Cancer.

[41]  J. Pinsolle,et al.  Prognostic value of histologic findings in neck dissections for squamous cell carcinoma. , 1997, Archives of otolaryngology--head & neck surgery.