Cervical node metastasis from epidermoid carcinoma of the oral cavity and oropharynx. A critical assessment of current staging.

Abstract The clinical and histologic status of cervical lymph nodes has been correlated with the results of treatment in 1,069 consecutive patients who underwent radical neck dissection as part of the initial treatment of a primary epidermoid carcinoma arising in either the oral cavity or oropharynx. The influence on “cure” rates of size, number, location, and fixation of involved nodes, correlated with the specific site of origin within the oral cavity, was evaluated in determinate patients with proved nodal metastasis. As the extent of lymph node involvement increased from solitary to multiple ipsilateral and to bilateral enlarged nodes, cure rates dropped progressively. Survival was not invariably decreased in those whose involved nodes were large or considered fixed, and there was considerable variance among examiners when size and fixation were evaluated. These data suggest that the N system of staging presently advocated might be improved. Rather than designating contralateral or bilateral node involvement as N 2 , this category might be reserved for those with multiple ipsilateral cervical node metastases. Those with contralateral and bilateral as well as so-called fixed metastases might better be relegated to the N 3 category. The results of treatment were uniformly poor in the latter group of patients, provided the term “fixed” indicated immobility of involved lymph nodes and not merely the presumption that tumor had extended beyond the capsule of the node.