ABSTRACT
<p><b>OBJECTIVE</b>To investigate the risk factor for metastasis in Level IV of ipsilateral neck in tongue cancer patients.</p><p><b>METHODS</b>A total of 248 tongue caner paitents (255 necks) that underwent radical neck dissection was enrolled in the study. Chi-square test and Logistic regression analysis were used to determine the factors associated with metastasis in Level IV. The variable included age, sex, growth type, T stage, histopathological grade, Level III involvement, number of positive lymph nodes in Levels I-III.</p><p><b>RESULTS</b>Out of 147 cases (152 necks) with positive lymph node, 21 necks (8.2%, 21/255) had Level III involvement, and 2 necks (0.8%, 2/255) developed skip metastasis. Chi-square test showed that age (P = 0.020), Level III involvement (P = 0.000), number of positive Level (≥ 2 Levels) in Levels I-III (P = 0.006), and number of positive lymph node (≥ 3 nodes) in Levels I-III (P = 0.000) were identified as independent risk factor. Logistic regression analysis revealed that only Level III involvement (P = 0.003) was the risk factor for metastasis in Level IV.</p><p><b>CONCLUSIONS</b>In tongue cancer patients, Level III involvement was a high risk factor for metastasis in Level IV.</p>