Prognostic importance of paratracheal lymph node metastases

Objectives. The aim of this retrospective study was to evaluate the prognostic significance of paratracheal lymph node (PTLN) metastases for tumor recurrence and survival for patients treated with total laryngectomy (TL) and PTLN dissection. Study Design: Records from 85 patients who underwent TL combined with PTLN dissection for laryngeal or hypopharyngeal carcinomas were reviewed. Results. In 20 of 85 (24%) patients, PTLN metastases were found, and in 7 patients, extranodal spread (ENS) was present in these metastases. The incidence of PTLN metastases was high in patients with hypopharyngeal or cervical esophageal (35%) and laryngeal carcinoma with subglottic extension (27%). Multivariate analysis shows that the most important prognostic factor for overall survival is the presence of PTLN metastases with ENS (P <.0005). Conclusions. Because PTLN metastases with ENS is an important prognostic factor and can only be assessed by histopathologic examination, PTLN dissection in patients with a laryngeal or hypopharyngeal tumor is important for prognostication. Key Words. Squamous cell carcinoma, larynx, hypopharynx, total laryngectomy, paratracheal lymph node metastases, prognosis.