Quantitative analysis of the extent of extracapsular invasion and its prognostic significance: a prospective study of 170 cases of XXXX and hypopharynx.

@entity1 @entity135 @entity5 @entity957 @entity189 @entity2802 @entity397 @entity3 @entity204
BACKGROUND: The extracapsular spread of disease in modal @entity3 of head and @entity135 is an important prognostic factor. However, the implications of the degree of capsular involvement are rarely mentioned. This is a prospective study which intends to investigate the role of transcapsular spread in metastatic lymph nodes on the outcome of @entity1 with @entity189 . METHODS: This is a prospective study of 170 consecutive cases of previously untreated @entity1 with @entity957 or the hypopharynx treated from January 1981 through January 1988 at the Head and Neck Service of the Heli  polis Hospital Complex, S  o Paulo, Brazil. In an attempt to understand better the influence of the extension of capsular lymph node involvement on recurrence and actuarial survival rates, the Kaplan-Meier method and Mantel-Cox test were used. RESULTS: The nodal cervical relapse was associated only to a macroscopic transcapsular spread (confidence interval, 1.7-7.0). When the @entity189 was confined to the lymph node or only a microscopic transcapsular spread was present, no statistically significant differences were found in recurrence or in @entity204 rates. The 5-year global and disease-free actuarial survival rates were, respectively, 52.0% and 56.8% for cases without @entity3 and 5.8% and 10.2% when macroscopic transcapsular spread was present (p < .0001). The capsular @entity397 was the most important independent prognostic factor associated with the N categories of the @entity2802 clinical classification and with metastatic lymph node diameter. CONCLUSIONS: The risks of recurrence and @entity204 are higher when there is macroscopic extracapsular extension. When the @entity5 is confined to the lymph node or shows a microscopic invasion beyond the capsule, there are no statistically significant differences in risk rates. The risk of capsular @entity397 is related to the N category of the classification @entity2802 and the diameter of the metastatic lymph node, from 3 cm and larger.
