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Histopathologic Predictors of Recurrence After Neck Dissection in Patients With Lymph Node Involvement

Kerry D. Olsen, MD; Michela Caruso, MD; Robert L. Foote, MD; Robert J. Stanley, MD; Jean E. Lewis, MD; Steven J. Buskirk, MD; LCDR Deborah A. Frassica, MC, USN; Lawrence W. DeSanto, MD; W. Michael O'Fallon, PhD; Verna R. Hoverman

Arch Otolaryngol Head Neck Surg. 1994;120(12):1370-1374.

Abstract
Objective
Retrospectively analyze several histopathologic variables that may predict neck recurrence after neck dissection.

Design
From 1970 through 1980, 284 patients with pathologically confirmed metastatic squamous cell carcinoma underwent neck dissection and received no adjuvant therapy. Kaplan-Meier evaluation estimated a 74% 2-year neck recurrence–free rate. After adjusting for the standard covariates of age, gender, neck stage, and tumor grade, we also controlled for the time-dependent co-variates of primary recurrence, occurrence in the side of the neck not operated on, or development of new head and neck primary disease.

Setting
A large referral-based practice.

Results
The number of lymph nodes involved, invasion of vascular/lymphatic space, invasion of soft tissue, and desmoplastic lymph node pattern adversely affect neck recurrence. A desmoplastic stromal pattern was associated with almost a sevenfold increased risk of neck recurrence. To our knowledge, this finding has not been reported previously.

Conclusion
Histopathologic evaluation of metastatically involved cervical nodes can identify patients with head and neck cancer who are at high risk for recurrence.

(Arch Otolaryngol Head Neck Surg. 1994;120:1370-1374)

Author Affiliations
From the Department of Otorhinolaryngology (Drs Olsen and Stanley), the Division of Radiation Oncology (Drs Caruso, Foote, and Frassica), the Section of Surgical Pathology (Dr Lewis), the Section of Biostatistics (Dr O'Fallon and Ms Hoverman), Mayo Clinic and Mayo Foundation, Rochester, Minn; the Department of Radiation Oncology, Mayo Clinic, Jacksonville, Fla (Dr Buskirk); and the Section of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Scottsdale, Ariz (Dr DeSanto).

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