Soft tissue deposits from head and neck cancer: an under-recognised prognostic factor?

Prognostic factors have considerable influence in the management of cancer, and the quest for a thorough understanding of these elements remains one of the holy grails of surgeons and oncologists. In squamous cell carcinoma of the head and neck, the presence or absence of cervical lymph node metastases at presentation has been identified as the single most important independent factor affecting prognosis. Overall, the presence of nodal metastasis reduces the five-year survival rate by approximately 50 per cent. Prognostic factors which have been identified include the size of the largest metastatic deposit within a lymph node, the number of lymph nodes involved and the location of those lymph nodes (that is, positive level IV and V nodes carry a worse prognosis than higher level nodes). In the past few years, extracapsular spread has increasingly been recognised as another crucial prognostic factor. Macroscopic and microscopic extracapsular spread adversely affect the outcome in oncological patients. The finding of cervical soft tissue tumour deposits, on the other hand, represents a phenomenon which may be tremendously influential prognostically. However, this is a finding which, to date, has been grossly under-reported and unrecognised in clinical studies of head and neck cancer.