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Prospective Analysis of Prevalence, Survival, and Its Implications

Jemy Jose, FRCS; James W. Moor, MRCS; Andrew P. Coatesworth, FRCS(ORL-HNS); Colin Johnston, MSc; Ken MacLennan, DM, FRCPath

Arch Otolaryngol Head Neck Surg. 2004;130:157-160.

Background  Soft tissue deposits of squamous cell carcinoma in the necks of patients with squamous cell carcinoma of the upper aerodigestive tract may represent either total effacement of a lymph node by carcinoma or extralymphatic deposits of carcinoma. There are few reports of their clinical or prognostic significance.

Methods  Data from 215 neck dissections from 155 patients with squamous cell carcinoma of the upper aerodigestive tract were studied prospectively to assess the prevalence of soft tissue deposits within the neck. The case notes of these patients were subsequently reviewed to analyze the effect on both the overall survival and recurrence-free survival.

Results  The prevalence rate for soft tissue deposits occurring alone was 10.3%; the prevalence rate for soft tissue deposits occurring with extracapsular spread was 13.5%. The overall prevalence rate for soft tissue deposits was 23.9%. There was a statistically significant reduction in actuarial and recurrence-free survival in patients with soft tissue deposits compared with patients with pathologically node-negative necks (P = .001), and in patients with soft tissue deposits compared with those with pathologically node-positive necks without extracapsular spread (P = .001). No statistically significant differences were found between patients with soft tissue deposits and patients with pathologically node-positive necks with extracapsular spread, for actuarial survival or recurrence-free survival.

Conclusions  In this series, soft tissue deposits were associated with an aggressive clinical course and poor survival. It is therefore important that histopathologists agree on a uniform terminology when reporting soft tissue deposits and actively look for their presence when examining neck dissection specimens.

From the Department of Otolaryngology, Head and Neck Surgery, Leeds General Infirmary, Leeds, England (Messrs Jose and Moor); Department of Otolaryngology, York District Hospital, York, England (Mr Coatesworth); and the Cancer Research UK Clinical Cancer Center, St James's University Hospital, Leeds (Mr Johnston and Dr MacLennan). The authors have no relevant financial interest in this article.

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