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Eberhard Stennert, MD; Dilek Kisner; Markus Jungehuelsing, MD; Orlando Guntinas-Lichius, MD; Ursula Schröder, MD; Hans Edmund Eckel, MD; Jens Peter Klussmann, MD

Arch Otolaryngol Head Neck Surg. 2003;129:720-723.

Objective  To analyze the incidence and risk factors for clinically apparent and occult lymph node metastases in patients with major salivary gland cancers.

Design  Cohort of patients with a median follow-up of 46 months (range, 1-174 months).

Setting  University-based referral center.

Patients  A total of 160 consecutive patients with complete clinical and pathologic data.

Intervention  Neck dissection was performed in all cases. Patients were treated with surgery alone (55%); surgery and radiation therapy (43%); or a combination of surgery, radiation, and chemotherapy (2%).

Main Outcome Measure  Incidence of apparent and occult lymph node metastases. Univariate and multivariate analyses were used to evaluate the significance of clinical and pathologic data.

Results  Histologically confirmed positive neck was found in 53% of all cases. Histologic diagnosis was significantly related to the incidence of lymph node metastasis: 89% (16/18) for undifferentiated carcinomas. However, so-called low-risk tumors had incidence rates of 22% to 47%. Twenty-one patients (13%) presented with clinically apparent cervical lymph node metastasis. Of the 139 patients with clinical N0 neck, 45% had occult neck metastasis. Neck metastasis was found in 29% (10/34) of T1, 54% (38/70) of T2, 65% (20/31) of T3, and 54% (16/25) of T4 tumors. Assessment of survival according to nodal status revealed significant correlations for overall (P<.001) and disease-free survival (P<.001).

Conclusions  We found a high incidence of lymph node metastasis from major salivary gland cancers. Neck dissections should be considered as an integral part of the surgical approach in patients with major salivary gland cancer, especially if no postoperative radiation therapy is planned.

From the Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany (Drs Stennert, Guntinas-Lichius, Schröder, and Klussmann and Ms Kisner); Department of Oto-Rhino-Laryngology, Klinikum Ernst von Bergmann, Potsdam, Germany (Dr Jungehuelsing); and Department of Oto-Rhino-Laryngology, Klagenfurt General Hospital, Klagenfurt, Austria (Dr Eckel). The authors have no relevant financial interest in this article.

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