Prognostic factors influencing contralateral neck lymph node metastases in oral and oropharyngeal carcinoma

Purpose: The prognostic influence of different clinicopathologic factors in contralateral lymph node metastases of oral and oropharyngeal squamous cell carcinoma (SCC) has been rarely described in the literature. Prediction of these contralateral metastases may be of relevance because this factor is strongly associated with poor prognosis. This study analyzed the relationship between predictor factors and the development of contralateral metastases in oral and oropharyngeal SCC.

Materials and methods: A series of 402 cases of oral and oropharyngeal SCC were analyzed retrospectively. Unilateral neck dissection was carried out in 190 patients, bilateral neck dissection in 101, and tumor resection without neck dissection in 111. The log-rank test was used for survival analysis of contralateral metastases. Correlation between different clinicopathologic factors and the presence of contralateral metastases was studied with the chi(2) test for univariate analysis and logistic regression for association of these factors and contralateral metastases in the multivariate analysis (P < .05).

Results: Of the patients, 20 (5.1%) had primary positive contralateral metastases in neck dissection specimens and 19 (4.8%) had contralateral recurrences at follow-up. When the 2 groups were taken into consideration, the rate of contralateral metastases of the series was 9%. Gender, tumor location, homolateral positive nodes, tumor extension across the midline, histologic grade, margin status, pattern of growth, and perineural spread were correlated with contralateral metastases in the univariate analysis (P < .05). However, homolateral lymph node metastases and extension across the midline were the most important predictors of contralateral metastases (P < .01) on multivariate logistic regression analysis. Positive contralateral metastases showed a strong correlation with a poor prognosis for survival in this study (P < .05).

Conclusion: Oral and oropharyngeal carcinomas with homolateral positive lymph nodes and tumor extension across the midline are at higher risk of contralateral lymph node involvement. Prediction of contralateral metastases may be useful in planning more aggressive therapies in patients with head and neck SCC with poor prognostic criteria.