Risk factors for neck failure in patients with squamous cell carcinoma of the tongue. Analysis of the pattern of cervical lymph node metastases

To clarify risk factors for neck failure, we analyzed the clinical and histopathological findings in node-positive cases of squamous cell carcinoma of the tongue.We reviewed the records of 342 patients with controlled primary tongue lesions who were treated between January 1974 and June 1999 at Chiba Cancer Center Hospital. Two hundred fifty-one patientswho had clinically or pathologically negative nodes or both were excluded from study. Among 91 patients with positive nodes, neck disease was controlled in 81, and neck failure developed in 10.The relations of various factors to the pattern of cervical lymph node metastasis in the 91 patients were investigated by multivariate analysis. Multiple logistic regression analysis showed that the odds ratio for neck failure diminished in the following order: level of metastasis 6.732 (p=.0197), presence of nodal adhesion 3.329, extracapsular spread 2.444, number of positive nodes 1.421, and node size 1.097.Of the 10 patients with neck recurrence, 9 had recurrence in areas confirmed to have positive nodes. Five patients with nodal adhesion had recurrence at the location of nodal adhesion.The presence of lower neck involvement may be a decisive factor for postoperative treatment. Patients with nodal adhesion should receive extended radical neck dissection with a sufficient margin, and postoperative treatment should be considered.