Staging of Cervical Lymph Node Metastasis

In 1977 the American Joint Commission (AJC) revised its system for classification of cervical lymph node metastasis producing a variation from the staging system of the International Union Against Cancer (UICC). A review of 356 evaluable patients was carried out to determine if the AJC or UICC system was prognostically superior. The primary sites of study were the supraglottic larynx in 181, tonsil in 98, and pyriform sinus in 77. All cases were staged using both the AJC and UICC criteria. All demographic, treatment, staging, and survival data were coded for computer entry and analysis. Pairwise comparisons were made for each possible N-class combination using the method of Lee and Desu. For the UICC, statistical difference was detected only between the absence or presence of cervical metastasis but did not statistically differentiate between N1, N2 or the N3 groups. The AJC system on the other hand was highly statistically discriminative between classes. Of 15 possible pairwise comparisons, two were not significantly different. The AJC system appears to be significantly more discriminative than the UICC system.