Extensive neck node metastases (N3) in XXXX : is radical treatment warranted?

@entity1 @entity135 @entity5 @entity2802 @entity213
OBJECTIVE: @entity213 ( @entity213 ) @entity1 with @entity135 at presentation are the minority. Prognosis for such @entity1 is poor, but there is disagreement about which treatment policy is best adopted. The aim of this study was to identify which groups of @entity1 are best offered radical treatment, examining factors of association, prognosis, and survival. STUDY DESIGN: Prospective cohort study. SETTING: Regional @entity135 unit. SUBJECTS AND METHODS: Data were collected prospectively from @entity1 treated for @entity213 with N3 nodal disease between 1975 and 2005. The data collected included age, sex, @entity5 @entity2802 stage, histological grade, treatment, and survival. Odds ratio was used to calculate whether each parameter was statistically significant. Tumor-specific and observed survival curves were also calculated. RESULTS: A total of 275 @entity1 had N3 disease. Multivariate analysis confirmed that advanced disease at the primary site (odds ratio = 4.6, P = .0261) mitigated against curative treatment. @entity5 -specific survival between curative and palliative treatment strategies suggests that aggressive treatment is associated with greatly improved survival (median survival = 1.45 years, 95% confidence interval [CI] = 1.23-1.67 years; 5-year survival = 26.6%, CI = 17.14%-36.06%) compared with those treated palliatively (median survival = 3.18 months, CI = 3.06-3.30 months; no 5-year survivors; P < .0001). CONCLUSION: A major factor in determining treatment strategies for N3 disease @entity213 is the extent of disease at the primary site. These data suggest that aggressive treatment of the neck improves survival and should be considered in these @entity1 .
