Premium
Patterns of nodal metastasis and prognosis in human papillomavirus–positive oropharyngeal squamous cell carcinoma
Author(s) -
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.
Publication year - 2014
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.23438
Subject(s) - medicine , oncology , ajcc staging system , stage (stratigraphy) , cohort , human papillomavirus , nodal , cancer , survival analysis , basal cell , head and neck squamous cell carcinoma , metastasis , staging system , head and neck cancer , biology , paleontology
Background 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. Methods 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 HPV+ N1 as a single node <6 cm, ipsilaterally, contralaterally, or bilaterally. HPV+ N2 was defined as a single node ≥6 cm or ≥2 nodes ipsilaterally/contralaterally or ≥3 nodes bilaterally. HPV+ N3 was defined as matted nodes. Results There was no significant difference in disease‐specific survival (DSS; p = .14) or overall survival (OS; p = .16) by AJCC classification. In patients grouped by HPV+ N1, HPV+ N2, and HPV+ N3 nodal classification, significant differences in DSS (100%, 92%, and 55%, respectively; p = .0001) and OS (100%, 96%, and 55%, respectively; p = .0001) were found. Conclusion 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. Head Neck 36: 1233–1240, 2014