Patterns of nodal metastasis and prognosis in human papillomavirus–positive oropharyngeal squamous cell carcinoma. Issue 9 (20th January 2014)

• Record Type: Journal Article
• Authors: Spector, Matthew E.; Gallagher, K. Kelly; Bellile, Emily; Chinn, Steven B.; Ibrahim, Mohannad; Byrd, Serena; Chanowski, Eric J.; Walline, Heather M.; Moyer, Jeffrey S.; Prince, Mark E.; Wolf, Gregory T.; Bradford, Carol R.; McHugh, Jonathan B.; Cordell, Kitrina; Carey, Thomas; Worden, Francis P.; Eisbruch, Avraham; Chepeha, Douglas B.
• Is Part Of: Head & neck. Volume 36:Issue 9(2014:Sep.)
• Page Start: 1233
• Page End: 1240
• Publication Date: 2014-01-20
• Subjects: Head -- Diseases -- Periodicals; Neck -- Diseases -- Periodicals; Head -- Periodicals; Neck -- Periodicals; Face -- Periodicals; 617.51059
• DOI: 10.1002/hed.23438
• Languages: English
• ISSNs: 1043-3074

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="hed23438-sec-0001" sec-type="section"> <title>Background</title> <p>The current American Joint Committee on Cancer (AJCC) staging system may not accurately reflect survival in patients with human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (SCC). The purpose of this study was to develop a system that more precisely predicts survival.</p> </sec> <sec id="hed23438-sec-0002" sec-type="section"> <title>Methods</title> <p>CT scans from 156 patients who underwent chemoradiation for advanced‐stage oropharyngeal SCC with >2 years follow‐up were reviewed. We modeled patterns of nodal metastasis associated with different survival rates. We defined <sub>HPV+</sub>N1 as a single node <6 cm, ipsilaterally, contralaterally, or bilaterally. <sub>HPV+</sub>N2 was defined as a single node ≥6 cm or ≥2 nodes ipsilaterally/contralaterally or ≥3 nodes bilaterally. <sub>HPV+</sub>N3 was defined as matted nodes.</p> </sec> <sec id="hed23438-sec-0003" sec-type="section"> <title>Results</title> <p>There was no significant difference in disease‐specific survival (DSS; <italic>p</italic> = .14) or overall survival (OS; <italic>p</italic> = .16) by AJCC classification. In patients grouped by <sub>HPV+</sub>N1, <sub>HPV+</sub>N2, and <sub>HPV+</sub>N3 nodal classification, significant differences in DSS (100%, 92%, and 55%, respectively; <italic>p</italic> = .0001) and OS (100%, 96%, and 55%, respectively; <italic>p</italic> = .0001) were found.</p> </sec> <sec id="hed23438-sec-0004" sec-type="section"> <title>Conclusion</title> <p>A staging system with reclassification of size, bilaterality, and matted nodes more accurately reflects survival differences in this cohort of patients. Review of the AJCC staging system with these criteria should be considered for HPV‐positive oropharyngeal SCC. © 2014 Wiley Periodicals, Inc. <italic>Head Neck</italic> 36: 1233–1240, 2014</p> </sec> </abstract>