Lymph node metastasis of glottic laryngeal carcinoma

The incidence of lymph node metastases in glottic cancer is assumed to be lower than in other head and neck cancers. in a retrospective study this statement was investigated. Material and Methods: This analysis was based on 910 consecutive patients with glottic carcinoma treated between 1970 and 1990 by means of surgery with special interest on regional lymph node metastases. Results: 8,6% patients had clinically positive necks (N+) and 5,9% pathohistologically positive necks (pN+). The incidence of lymph node metastases showed correlation with pT category and vocal cord mobility. Lymph node metastases were found in 5% of pT2, in 18% of pT3 and in 32% of pT4 tumors. Only one patient with pT1 cancer had metastatic lymph node involvement. The incidence of occult lymph node metastases was 18%. Lymph node involvement, extracapsular spread and lymphangiosis carcinomatosa proved to be relevant prognostic factors. The 5 year recurrent free survival rate was 86,7% for the whole group, 81,6% for patients with negative nodes (pN0), and 61,8% for patients with pN+ nodes (p < 0,001 according to logrank test). Conclusions: Clinical lymph node staging plays an important prognostic role in the staging procedure also in glottic carcinoma. At least in T3 carcinomas, elective treatment of the cervical lymph nodes seems to be necessary. T2 carcinomas with impaired cord mobility have a significant higher risk for metastatic spread; therefore neck dissection should be discussed also in these cases.