Lymph node metastasis as a prognostic factor in laryngeal cancer

The authors reviewed the prognostic importance of several lymph node metastasis-related factors. The presence of lymph node metastasis from laryngeal cancer significantly reduces the probability of regional control and survival. Proper management of the neck remains a therapeutic dilemma because there are no precise means for evaluating lymph nodes. A comprehensive neck dissection adjuvant radiotherapy has been relied as the proper treatment for cases with positive lymph nodes. On the other hand, there is no consensus over whether or not and how to perform an elective neck treatment in patients with laryngeal carcinoma. Several variables related to cervical lymph node involvement and their implication on prognosis were studied in the literature (site, size, extracapsular extension, number). In an analysis of 3-year survival rates showed that patients with clinically detectable regional metastasis (N stage) exhibited poorer disease free interval (DFI) and overall survival (OS) than those classified as N-. Also patients with high number, or larger, or ruptured metastatic nodes experienced poor prognosis (marginally significant statistically). The highest impact on survival were exhibited by the involvement of contralateral lymph nodes adn extracapsular extension. It is our opinion that cases with clinically positive nodes should be submitted to a comprehensive neck dissection (either classical or modified); at least a selective dissection as a staging procedure when the supraglottis is involved. It is a advisable to perform an elective comprehensive neck dissection when a satisfactory clinical assessment cannot be made or when there are factors that would prevent adequate follow-up.