Significance of Extracapsular Lymph Node Metastases in Patients with Head and Neck Squamous Cell Carcinoma

The presence of cervical lymph node metastasis remains the most significant prognostic indicator of survival and disease recurrence in patients with squamous cell carcinoma of the head and neck. An approximately 50% reduction in 5-year survival rate is seen with the development of lymph node metastasis in patients with squamous cell carcinoma of the head and neck. A further precipitous and significant decline in survival and an unacceptably high rate of local-regional and distant failure occurs when extracapsular spread of lymph node metastasis is present. Extracapsular spread is noted in a majority of the lymph nodes larger than 3 cm and in a significant number of nodes less than 2 cm. Extracapsular spread has even been demonstrated in lymph nodes measuring less than 1 cm. Extracapsular spread, thus, is the most important predictor of survival, local-regional recurrence, and distant metastasis. The spread of metastatic disease beyond the lymph node capsule demands aggressive therapy directed toward local-regional disease and addressing the high incidence of distant metastases.