Natural history of neck disease in patients with squamous cell carcinoma of oropharynx and pharyngolarynx.

Out of a series of 2040 patients referred to the Institut Curie with squamous cell carcinoma of oropharynx and pharyngolarynx, 1666 cases were evaluated on admission regarding the characteristic metastases patterns to their cervical lymph nodes. Incidence and topographic distribution of lymph nodes are correlated with the anatomic sites of primary lesions. Biological virulence of these tumors is emphasized since the overall incidence of positive neck nodes attains 63% (1048/1666) and advanced disease, stage IV in the UICC classification, 61%. Cervical status is also related to several characteristics of the primary: clinical staging and variety, and histopathological differentiation. Ipsilateral cervical involvement is characterized by the high incidence of metastases in the jugular chain for the whole series, in the submaxillary group for oropharyngeal carcinomas and in the spinal accessory chain for cancer of the pharyngolarynx (pyriform sinus and lateral epilarynx). Preliminary therapeutic implications are derived from this nodal distribution. Comparisons are established between the 1978 UICC and 1976 AJC classifications, showing a good correlation despite multiple differences in staging criteria. It is shown that assessment combining both the multiplicity and the volume of cervical metastases allows to evaluate more accurately the aggressiveness of the primary.