We retrospectively analyzed 81 patients who were diagnosed with pathological N2c（pN2c）squamous cell carcinoma of the head and neck between January 2001 and December 2013 at Kurume University Hospital or other facilities. Patients comprised 74 males and 7 females, with a median age of 62（range, 29-89）years. Primary sites included the oral cavity（n＝22）, oropharynx（n＝8）, larynx（n＝13）, and hypopharynx（n＝38）. Age, gender, primary sites, T classification, degree of differentiation, neoadjuvant chemotherapy, adjuvant chemotherapy, surgical margin, neck metastasis to level 4, extracapsular spread, size of positive nodes, and number of positive nodes were selected as affected factors for consideration as locoregional, distant metastatic, and prognostic factors. Multivariate analysis identified surgical margin, number of positive nodes and T classification, and number of positive nodes as locoregional, distant metastatic, and prognostic factors, respectively. Patients with pN2c squamous cell carcinoma experienced distant metastasis and poor prognosis based on the increase in the number of positive nodes. We believe that adjuvant therapy was necessary for those high-risk patients.