Cystic nodal metastasis in patients with oropharyngeal squamous cell carcinoma receiving chemoradiotherapy: Relationship with human papillomavirus status and failure patterns

Huang, Yu Jie; Yeh, Chih‐Hua; Cheng, Nai Ming; Lin, Chien Yu; Wang, Hung Ming; Ko, Sheung Fat; Toh, Cheng Hong; Yen, Tzu Chen; Liao, Chun Ta; Ng, Shu Hang

doi:10.1371/journal.pone.0180779

Cited by 32 publications

(31 citation statements)

References 26 publications

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“…Before evaluation, the two neuroradiologists completed a training session with five patients to help them reach a consensus on evaluation of the imaging findings. Lymph nodes were considered as positive for radiologic ENE when at least one of the following criteria was met (92021222324): 1) enhancement, thickening, and irregularity of the nodal rim and 2) infiltration of the adjacent fat or other soft tissue planes (Fig. 2).…”

Section: Methodsmentioning

confidence: 99%

Prognostic Value of Radiologic Extranodal Extension in Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma

et al. 2019

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Objective To determine whether radiologic extranodal extension (ENE) appearing on pretreatment CT and MRI could predict the prognosis in patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). Materials and Methods The study population was obtained from a historical cohort diagnosed with HPV-related OPSCC. A total of 134 OPSCC patients who had a metastatic lymph node on pretreatment CT or MRI were included, and radiologic ENE was evaluated by two experienced head and neck radiologists. Kaplan-Meier and multivariate Cox regression analyses were performed to evaluate the impact of radiologic ENE on progression-free survival (PFS). The diagnostic performance of CT and MRI for the diagnosis of ENE was also evaluated in patients who underwent neck dissection. Results Seventy patients (52.2%) showed radiologic ENE-positive findings. Although patients showing radiologic ENE had a worse 3-year PFS (83.7% vs. 95.3%, p = 0.023), the association between radiologic ENE and PFS was not statistically significant on multivariate analysis ( p = 0.141; hazard ratio, 2.68; 95% confidence interval, 0.72–9.97). CT or MRI had a sensitivity of 62%, specificity of 77.8%, and accuracy of 71.9% for predicting pathologic ENE. Conclusion Radiologic ENE on CT or MRI did not predict poor PFS in patients with HPV-related OPSCC, although there was a trend towards worse PFS. Further studies are warranted to determine whether radiologic ENE is a useful imaging biomarker to risk-stratify patients with HPV-related OPSCC.

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Section: Methodsmentioning

confidence: 99%

Prognostic Value of Radiologic Extranodal Extension in Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma

et al. 2019

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“…For primarily surgically treated cohorts it will be important in the future to identify risk factors in a prospective setting that are relevant for the patients’ prognosis because in Germany currently 75% of the OSCC patients undergo primary surgery. As an example, the cystic degenerated metastasis is mentioned, hereby poor local control rates after therapy without surgery are described 192 . In our own cohort, especially a young age could be identified as additional predictor for a good outcome of HPV OSCC patients 193 .…”

Section: Decision-making Tools For Therapymentioning

confidence: 99%

“…Für primär chirurgisch behandelte Kohorten wird es zukünftig bedeutsam sein auch in einem prospektiven Setting Risikofaktoren zu identifizieren, die für die Prognose der Patienten bedeutsam sind, denn in Deutschland werden aktuell 75% aller OSCC Patienten einer primär chirurgischen Therapie zugeführt. Beispielhaft kann die zystisch degenerierte Metastase angeführt werden, hier sind schlechte lokale Kontrollraten nach Therapie ohne Operation beschrieben 192 . In unserer eigenen Kohorte konnte für HPV OSCC insbesondere ein junges Lebensalter zusätzlich als Prädiktor für ein gutes outcome identifiziert werden 193 .…”

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HPV – Das andere Kopf-Hals-Karzinom

et al. 2018

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Head and neck cancer is the sixth most common cancer with over 500000 annually reported incident cases worldwide. Besides major risk factors tobacco and alcohol, oropharyngeal squamous cell carcinomas (OSCC) show increased association with human papillomavirus (HPV). HPV-associated and HPV-negative OSCC are 2 different entities regarding biological characteristics, therapeutic response, and patient prognosis. In HPV OSCC, viral oncoprotein activity, as well as genetic (mutations and chromosomal aberrations) and epigenetic alterations plays a key role during carcinogenesis. Based on improved treatment response, the introduction of therapy de-intensification and targeted therapy is discussed for patients with HPV OSCC. A promising targeted therapy concept is immunotherapy. The use of checkpoint inhibitors (e.g. anti-PD1) is currently investigated. By means of liquid biopsies, biomarkers such as viral DNA or tumor mutations in the will soon be available for disease monitoring, as well as detection of treatment failure. By now, primary prophylaxis of HPV OSCC can be achieved by vaccination of girls and boys.

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“…The distinct oncogenesis of HPV-positive OPSCC results in characteristic histopathology 4 , 5 , perfusion, and diffusion parameters, which are related to the angiogenesis and cellularity of the tumour. Several studies have reported diagnosis of the HPV status in patients with OPSCC using preoperative computed tomography (CT) or magnetic resonance (MR) imaging 6 – 8 . HPV-positive OPSCC tends to exhibit cystic cervical lymph node metastasis 6 – 8 and primary tumours with well-defined borders and an exophytic appearance 7 .…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have reported diagnosis of the HPV status in patients with OPSCC using preoperative computed tomography (CT) or magnetic resonance (MR) imaging 6 – 8 . HPV-positive OPSCC tends to exhibit cystic cervical lymph node metastasis 6 – 8 and primary tumours with well-defined borders and an exophytic appearance 7 . Recent studies reported that diffusion-weighted imaging (DWI) may help predict HPV status in patients with OPSCC, as HPV-positive OPSCC reveals a low mean apparent diffusion coefficient (ADC) compared with HPV-negative OPSCC 9 – 11 .…”

Section: Introductionmentioning

confidence: 99%

Oropharyngeal squamous cell carcinoma: radiomic machine-learning classifiers from multiparametric MR images for determination of HPV infection status

Suh

Lee

Choi

et al. 2020

Sci Rep

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We investigated the ability of machine-learning classifiers on radiomics from pre-treatment multiparametric magnetic resonance imaging (MRI) to accurately predict human papillomavirus (HPV) status in patients with oropharyngeal squamous cell carcinoma (OPSCC). This retrospective study collected data of 60 patients (48 HPV-positive and 12 HPV-negative) with newly diagnosed histopathologically proved OPSCC, who underwent head and neck MRIs consisting of axial T1WI, T2WI, CE-T1WI, and apparent diffusion coefficient (ADC) maps from diffusion-weighted imaging (DWI). The median age was 59 years (the range being 35 to 85 years), and 83.3% of patients were male. The imaging data were randomised into a training set (32 HPV-positive and 8 HPV-negative OPSCC) and a test set (16 HPV-positive and 4 HPV-negative OPSCC) in each fold. 1618 quantitative features were extracted from manually delineated regions-of-interest of primary tumour and one definite lymph node in each sequence. After feature selection by using the least absolute shrinkage and selection operator (LASSO), three different machine-learning classifiers (logistic regression, random forest, and XG boost) were trained and compared in the setting of various combinations between four sequences. The highest diagnostic accuracies were achieved when using all sequences, and the difference was significant only when the combination did not include the ADC map. Using all sequences, logistic regression and the random forest classifier yielded higher accuracy compared with the that of the XG boost classifier, with mean area under curve (AUC) values of 0.77, 0.76, and 0.71, respectively. The machine-learning classifier of non-invasive and quantitative radiomics signature could guide the classification of the HPV status.

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Cystic nodal metastasis in patients with oropharyngeal squamous cell carcinoma receiving chemoradiotherapy: Relationship with human papillomavirus status and failure patterns

Cited by 32 publications

References 26 publications

Prognostic Value of Radiologic Extranodal Extension in Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma

Prognostic Value of Radiologic Extranodal Extension in Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma

HPV – Das andere Kopf-Hals-Karzinom

Oropharyngeal squamous cell carcinoma: radiomic machine-learning classifiers from multiparametric MR images for determination of HPV infection status

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