Clinical nodal stage is an independently significant predictor of distant failure in patients with squamous cell carcinoma of the larynx.

Abstract

To determine the impact of clinical nodal stage on distant metastasis (DM) in patients with squamous cell carcinoma of the larynx (SCCL). Six hundred sixty-two previously untreated SCCL patients treated at a tertiary care cancer center from January 1984 to December 1998 were eligible for analysis. The end point of interest was development of DM following treatment. Distant metastasis-free survival (DMFS) was calculated by the Kaplan-Meier method; predictors of outcome were identified by univariate and multivariate analysis. The primary tumor site was glottic in 55%, supraglottic in 40%, and trans/sub glottic in 5%; 40% had locoregionally advanced (stage III/IV) tumors. At initial presentation, 25% of patients (12% N1, 11% N2, and 2% N3) had clinically metastatic nodes. DM were recorded in 67 patients (10%; lung, 45%; soft tissue, 13%; bone, 10%; multiple sites, 28%). The median time to DM was 18 months (range, 1-109). With a median follow-up of 60 months, the 5-year DMFS was 88%. Even after accounting for the type of index treatment, the only significant predictor of worse DMFS on multivariate analysis was a higher clinical N stage (P < 0.0001). The relative risk for DM was 0.5 (95% CI, 0.2-1.4; P = NS) for cN1, 3.2 (95% CI, 1.7-5.9; P < 0.0001) for cN2, and 7.5 (95% CI, 3.1-17.9; P < 0.0001) for cN3 disease compared with clinically N0 patients. Regardless of the index treatment modality, primary tumor site, or T stage, a higher clinical N stage at the time of presentation independently and significantly increases the risk of DM in patients with SCCL.