Prognostic impact and risk factors of level IV/V lymph nodes metastasis in laryngeal squamous cell carcinoma.

OBJECTIVES

This study systematically assessed the risk factors and prognostic significance of level IV/V metastasis in patients diagnosed with laryngeal squamous cell carcinoma (LSCC).

MATERIALS AND

METHODS

Patients with pathologically positive lymph nodes who underwent pharyngolaryngectomy and neck dissection and were subsequently treated with postoperative radiotherapy or concurrent chemoradiotherapy in two distinguished medical centers in China were analyzed.

RESULTS

Among the 361 patients, 116 (32.1 %) developed metastasis in level IV and 53 (14.7 %) in level V. Bilateral positive lymph nodes, extranodal extension, vascular/lymphatic invasion, pN3 classification were significantly associated with metastasis to level IV or V. Both level IV and V lymphadenopathy had a significantly adverse impact (p < 0.001) on the 5-year locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS), overall survival (OS), and cancer-specific survival (CSS). Level IV metastasis was independently (p < 0.05) associated with shorter OS (HR = 1.782), CSS (HR = 2.091), LRFS (HR = 3.456), and DMFS (HR = 1.927). Patients with level IV/V disease exhibited decreased survival rates across stages pN1 to pN3. Postoperative chemoradiotherapy significantly improved OS and CSS in patients with level IV or V lymphadenopathy.

CONCLUSIONS

Metastasis to level IV/V correlated with worse prognosis in LSCC patients and should be considered for future staging system refinements. An aggressive therapeutic approach may be suitable for patients with level IV/V lymphadenopathy.