Predictors of extracapsular spread in lymph node metastasis.

We investigated effect of clinical and pathologic parameters on extracapsular spread (ECS) in patients with lymph node metastasis in laryngeal and hypopharyngeal cancer. About 186 patients and 342 neck dissection were included in this study. Relationship between ECS and tumor location, T stage, pathologic N stage, tumor differentiation, number of metastatic lymph nodes, diameter of metastatic lymph node and impact of presence ECS on contralateral neck metastasis (CNM) were evaluated; 76 of the 186 patients had lymph node metastasis. Of the 76 patients, 31 (40.7%) had ECS. Tumor location, pathologic N stage of the tumor, number of metastatic lymph nodes, diameter of metastatic lymph node and the presence of CNM were significantly associated with ECS (P < 0.05). Only number of (>or=3) lymph node metastasis emerged as significant independent predictor of ECS (P < 0.05; OR:11.6). In conclusion, the number of metastatic lymph nodes (>or=3) should be used as predictor of ECS. Furthermore, contralateral neck dissection should be performed in patients with ipsilateral lymph node metastasis with ECS.