The accuracy of clinical neck staging for p16-positive and negative oropharyngeal cancer and its therapeutic implications

Abstract

Purpose Oropharyngeal squamous cell carcinoma (OPSCC) may be treated with primary surgery or primary (chemo)radiation. While surgery with concurrent neck dissection provides definitive pathological staging of the neck, non-surgical treatment relies on clinical staging for treatment planning. To assess the accuracy of clinical neck staging, we compared clinical to surgical staging after primary surgery in patients with p16-negative and p16-positive OPSCC. Methods Retrospective analysis of clinical, pathological, and oncologic outcome data of patients with OPSCC treated with primary surgery and bilateral neck dissection. Clinical and pathological nodal status were compared for p16-negative and p16-positive patients. Patients with occult metastatic disease were analyzed in detail. Results 95 patients were included. 60.5% of p16-negative patients and 66.6% of p16-positive patients had pathologically confirmed metastatic neck disease. p16-positive patients had improved 24-month recurrence-free survival compared to p16-negative patients at 93.3% vs. 69.6%. Pathological N-status differed from clinical N-status in 36.8% of p16-negative patients vs. 31.6% of p16-positive patients. Occult metastatic disease was more common in p16-negative patients at 18.4% vs. 8.8% for p16-positive patients. Clinical detection sensitivity for extranodal extension was low overall; sensitivity was 27.3% and specificity was 91.6% for p16-negative patients vs. 61.5% and 80.0% for p16-positive patients, respectively. Conclusion Our data show a considerable degree of inaccuracy of clinical neck staging results in all OPSCC patients which needs to be taken into consideration during therapy planning. For p16-positive patients, these findings warrant attention in the context of therapy deintensification to avoid undertreatment.

Comprehensive analysis of cuproptosis‐related gene expression and positive correlations with CD4+ T cell infiltration in head and neck squamous cell carcinoma

“…28,29 For example, Hussain et al analyzed 2-year recurrence-free survival in 95 HNSCC patients and showed that prognosis was better in p16-positive patients than in p16-negative patients (93.3% vs. 69.6%). 30 Moreover, Deneka et al 31 analyzed genomic data from more than a thousand HNSCC tumors and found that CDKN2A defects were linked to elevated TMB.…”

“…Correlations between cuproptosis‐related genes and immune checkpoints 52 were analyzed through Pearson's correlation coefficient. Correlations between gene expression and infiltration of immune cells were analyzed using the Tumor IMmune Estimation Resource (TIMER, https://cistrome.shinyapps.io/timer/), 53 Estimate the Proportion of Immune and Cancer cells (EPIC, http://epic.gfellerlab.org/), 54 Gene Expression Profiling Interactive Analysis 2 (GEPIA2, http://gepia2.cancer-pku.cn/#index), 55 and Estimation of STromal and Immune cells in MAlignant Tumour tissues using Expression data (ESTIMATE, https://bioinformatics.mdanderson.org/estimate/index.html). 56 …”

Nodale Metastasierung und Stellenwert der Neck Dissection bei T1/2-Oro- und Hypopharynxkarzinomen

“…Bei Patienten mit p16-positiven OPSCC wurde im Rahmen der operativen Primärtherapie in 66,3 % (55/83) der Fälle eine beidseitige und in 31 Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.…”

“…Im Stadium T1/2cN0 waren bei p16-negativen Tumoren lediglich in 9,1 % und bei p16-positiven Tumoren im Stadium T1/2 keine okkulten kontralateralen Lymphknotenmetastasen nachweisbar. Das Fehlen okkulter kontralateraler Metastasten bei p16-positiven Tumoren im Stadium cT1/2cN0 in unserer Studie ist möglicherweise darauf zurückzuführen, dass sich Lymphknotenmetastasen klinisch früher manifestieren, da diese sich im Vergleich zu p16-negativen Tumoren zumeist größer und zystisch konfiguriert sind [15,30,31]. Zudem ist der Anteil an Oropharynxkarzinomen des Zungengrundes in dieser Studienpopulation niedriger [32].…”