Human Papillomavirus–Associated Oropharyngeal Cancer: Patterns of Nodal Disease

Abstract

Objective To characterize patterns of neck lymph node (LN) metastases in human papillomavirus (HPV)–associated oropharyngeal squamous cell carcinoma, represented by p16 positivity (p16+OPSCC). Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Neck dissection (ND) specimens of nonirradiated p16+OPSCC patients were analyzed for frequencies of clinically evident and occult LNs by neck level. Local, regional, and distant recurrences were reviewed. Results Seventy p16+OPSCC patients underwent primary site transoral robotic surgery and 82 NDs of varying levels. Metastatic pathologic LNs were found at the following frequencies: 0% (0/28) in level I, 75.6% (62/82) in level II with 57.4% (35/61) in level IIA and 13.1% (8/61) in level IIB, 22.0% (18/82) in level III, 7.0% (5/71) in level IV, and 6.3% (1/16) in level V. The level V LN was clinically evident preoperatively. Five of 21 (23.8%) elective NDs contained occult LNs, all of which were in level II and without extranodal extension. Twenty-seven (38.6%) patients underwent adjuvant radiation; 19 (27.1%) patients underwent adjuvant chemoradiation. With a mean follow-up of 29 months, 3 patients had developed recurrences, with all but 1 patient still alive. All patients who recurred had refused at least a component of indicated adjuvant treatment. Conclusions For p16+OPSCC, therapeutic NDs should encompass any levels bearing suspicious LNs and levels IIA-B, III, and IV, while elective NDs should be performed and encompass at least levels IIA-B and III. These selective ND plans, followed by indicated adjuvant treatment, are associated with a low nodal recurrence rate.

Positive margin rates and predictors in transoral robotic surgery after federal approval: A national quality study

“…Importantly, there was potentially a relatively low rate of ECE (23.2%) in this study as compared to other reports in the literature. 27 However, a minority of patients were missing data for ECE; of those with known data, the rate of ECE was 27.8%, similar to some other oropharynx studies. 28,29 It is still possible that there is selection bias to not operate on those with obvious ECE preoperatively; however, we do not believe that such selection bias would affect margin rates.…”

“…Both facility factors yielded a P value less than .2. On multivariable regression, patients with LVI were 1.6 times as likely to have [26][27][28][29][30][31][32][33][34][35].93], P < .001). When T4a and T4b were grouped into a single category on multivariable regression, T classification remained a significant predictor of margin status (for T4, OR: 6.94, CI: 3.14-15.30, P < .001), and the rest of the model was unchanged.…”

Predictors of Mortality in HPV‐Associated Oropharynx Carcinoma Treated With Surgery Alone

“…Several studies have demonstrated a better quality of life (QOL) in patients who underwent primary surgery for OPSCC . Recent single and dual‐institutional studies show that primary surgical treatment has a comparable OS to primary chemoradiation . Up‐front surgery also has an additional advantage of histopathologic staging …”

The frequency of lymph node metastases by neck level in p16 positive oropharyngeal squamous cell carcinoma

“…Of three published studies examining the nodal distribution specific to p16 + ve disease, 5-7 one subclassified clinically known and occult nodes. 5 Previous studies examined the distribution of known and occult OPSCC nodal disease irrespective of p16 status, 2,[8][9][10][11] with HPV relatively recently demarcated as a specific disease subtype. 12 Zenga et al examined a large cohort of 324 pN + ve p16 + ve OPSCC patients, but without assessing the neck level distribution of LNs.…”