Predictors of contralateral‐bilateral nodal disease in oropharyngeal cancer: A National Cancer Data Base Study

Kato, Masanari; Ellis, Mark A.; Nguyen, Shaun A.; Day, Terry A.

doi:10.1002/hed.24964

Cited by 25 publications

(25 citation statements)

References 26 publications

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“…With regard to contralateral and bilateral disease, the majority of patients in this cohort (6/9) had advanced tumors located in the base of tongue, mirroring prior studies. 22,23 These results support consideration of bilateral selective neck dissection for such patients.…”

Section: Discussionsupporting

confidence: 55%

Predictors and Prevalence of Nodal Disease in Salvage Oropharyngectomy

et al. 2019

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OBJECTIVES-Patients with recurrent oropharyngeal cancer often require extensive salvage surgery. In patients with clinically N0 necks, the indication for concurrent neck dissection remains unclear. The aim of this study is to determine predictors, prevalence and distribution of nodal disease in patients treated with salvage oropharyngectomy. STUDY DESIGN-Case series with data collection at a single tertiary academic NCI-designated comprehensive cancer center METHODS-We analyzed patients treated with prior radiation or chemoradiation with persistent, recurrent or second primary squamous cell carcinoma of the oropharynx requiring oropharyngeal resection between 1998 and 2017 (n=95). Clinical and oncologic characteristics and treatment outcomes were collected and statistical analyses were performed. RESULTS-The overall rate of nodal positivity was 21% (24/95) and the rate of occult nodal disease was 6% (4/65). Ipsilateral and contralateral level II were the most common areas to harbor positive nodes. Bivariate analysis revealed female sex (p=0.01), initial overall stage (p= 0.02) and N status (p=0.03), as well as recurrent overall and T stage (p=0.05) as predictors of nodal disease. On Multivariate analysis, recurrent T-stage continued to be significantly predictive of pathologic nodal disease. Both CT and PET-CT were moderately accurate in predicting nodal disease in the salvage setting (AUC 0.79 and 0.80 respectively).CONCLUSION-Occult nodal disease is observed in few patients undergoing salvage oropharyngeal resection. This study identifies predictive factors for nodal disease in patient undergoing salvage oropharyngectomy and appropriate diagnostic tests in this setting.

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Section: Discussionsupporting

confidence: 55%

Predictors and Prevalence of Nodal Disease in Salvage Oropharyngectomy

et al. 2019

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“…Although the incidence of pCND was higher in their study (38.2%), this is likely due in part to their inclusion more advanced disease. Patients with clinical T3/T4 disease, not to mention clinical N3 disease, are known to have higher rates of pCND 7,14‐16 . Nevertheless, their data, along with that of other retrospective series, 17 provide additional evidence in favor of risk stratification for HPV‐associated base of tongue primary tumors.…”

Section: Discussionmentioning

confidence: 98%

Redefining risk of contralateral cervical nodal disease in early stage oropharyngeal cancer in the human papillomavirus era

et al. 2021

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Background The optimal extent of surgery and/or radiation to the contralateral lymph node region is unknown in early‐stage human papillomavirus (HPV)–related oropharyngeal squamous cell carcinoma (OPSCC). Methods To investigate the pathologic incidence of and risk factors for contralateral nodal disease (CND) in cT1‐T2 HPV‐related OPSCC treated with transoral robotic surgery (TORS) and bilateral neck dissection (BND), the records of 120 patients were reviewed. Results Eleven patients displayed pathologic contralateral nodal disease (pCND), including 7.1% of tonsil and 10.9% of base of tongue (BOT) cases. Medial hemistructure involvement and cN2 disease were significantly associated with pCND. Zero cN0 patients had pCND, and on multivariate analysis only cN classification remained significantly associated with pCND. Four percent of BOT patients and 2% of tonsil patients with a well‐lateralized primary and cN0/N1 neck demonstrated pCND. Conclusions HPV‐related OPSCC that are cN0‐N1 have exceedingly low rates of pCND. Well‐lateralized HPV‐related BOT primaries with limited clinical nodal disease may be candidates for ipsilateral only treatment.

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“…Although previous studies reported the rate of occult contralateral LN metastasis and its prognostic significance in p16+ OPSCC, its clinical relevance has not been established. Therefore, multicenter studies with larger sample sizes are required for further confirmation, and these findings should be taken into consideration when planning treatment for p16+ OPSCC …”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Lymph Node Status in p16+ Oropharyngeal Cancer After Surgical Treatment

Park

Koh

et al. 2020

The Laryngoscope

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Objectives/Hypothesis In this study, we retrospectively reviewed medical records of patients who underwent surgery for p16+ oropharyngeal cancer and analyzed the prognostic implications of pathologic lymph node (LN) status, including number of metastatic LNs, LN ratio, and location of metastatic LNs. Study Design Retrospective case series. Methods We retrospectively reviewed data on patients diagnosed with p16+ oropharyngeal cancer. Results The study population consisted of 159 males and 29 females with a mean age of 57.2 years. The primary tumor sites were tonsils (n = 160), base of the tongue (n = 24), and soft palate (n = 4). Only recurrence‐free survival (RFS) showed a significant correlation with contralateral LN metastasis on multivariate analysis. On Kaplan‐Meier analysis, 5‐year RFS was 92.4% in patients without contralateral LN metastasis and 68.8% in patients with contralateral LN metastasis. Conclusions Among pathologic LN status in p16+ oropharyngeal cancer, only contralateral LN metastasis showed prognostic significance in disease recurrence of p16+ oropharyngeal squamous cell carcinoma patients. Level of Evidence 4 Laryngoscope, 130: 1973–1979, 2020

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Predictors of contralateral‐bilateral nodal disease in oropharyngeal cancer: A National Cancer Data Base Study

Abstract: Patients with HPV-associated oropharyngeal SCC have increased likelihood of contralateral or bilateral nodal disease. Tumor grade, tumor location, and tumor size are also independent predictors.

Cited by 25 publications

References 26 publications

Predictors and Prevalence of Nodal Disease in Salvage Oropharyngectomy

Predictors and Prevalence of Nodal Disease in Salvage Oropharyngectomy

Redefining risk of contralateral cervical nodal disease in early stage oropharyngeal cancer in the human papillomavirus era

Prognostic Significance of Lymph Node Status in p16+ Oropharyngeal Cancer After Surgical Treatment

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