Clinicopathologic risk factors for distant metastases from head and neck squamous cell carcinomas

The aim of this study is to investigate the clinicopathologic risk factors associated with distant metastases (DMs) from head and neck squamous cell carcinomas (HNSCCs).

Between February 1990 and February 2000, a retrospective analysis of 391 HNSCC patients was performed. The frequency and the clinicopathologic risk factors for DM were evaluated by using univariate chi(2) tests and multiple stepwise logistic regression models. Statistical analysis of overall survival was performed by using Kaplan-Meier method.

44 patients (11.3%) developed DM in clinic. In a univariate analysis, clinical N stage, primary tumor site, level of tumor invasion, pathologic N stage and number of levels with pathologic lymph node were found to be significantly associated with the risk of DM. In a multivariate analysis, the most significant risk factors were number of levels with pathologic lymph node, level of tumor invasion, and primary tumor site. Kaplan-Meier analysis showed that overall survival rates of 44 patients with DMs in clinic were 56.8% at 1 year, 9.1% at 3 years, and 6.8% at 5 years, respectively.

The number of levels with pathologic lymph node, the site of primary tumor and the level of tumor invasion are decisive risk factors in determining the development of DM in head and neck SCC patients. Patients with multilevel nodal involvement in neck, with laryngeal and hypopharyngeal carcinomas, and patients with primary tumor invasion into muscular, bone or cartilage have the highest risk of developing DM.