The relevance of the lymph node ratio as predictor of prognosis is higher in HPV‐negative than in HPV‐positive oropharyngeal squamous cell carcinoma

Abstract

Prognosis of primarily operated HPV-positive patients might be more dependent on the extent of primary tumour site, whereas prognosis of HPV-negative patients is based more on cervical metastatic spread, represented by LNR.

Significance of Extranodal Extension in Surgically Treated HPV-Positive Oropharyngeal Carcinomas

“…The univariate analysis of the study by Meyer et al ( 40 ), which examined the prognostic influence of the lymph node ratio, also showed a significant influence of ENE on overall survival of HPV-positive patients with surgically treated OPSCC ( p = 0.012; ENE not included in the multivariate analysis) (surgery: n = 21, surgery + R(C)T: n = 67).…”

“…The univariate analysis of the study by Meyer et al (40), which examined the prognostic influence of the lymph node ratio, also showed a significant influence of ENE on overall survival of HPV-positive patients with surgically treated OPSCC (p = 0.012; ENE not included in the multivariate analysis) (surgery: n = 21, surgery + R(C)T: n = 67). In 2017 Zhan et al published results of their validation of the new staging system based on 3,745 cases of HPV-positive OPSCC treated by surgery and neck dissection from the National Cancer Database (NCDB) for the years 2010-2014 (surgery only: n = 642, surgery + RT: n = 1,005, surgery + CRT: n = 1,773) (38).…”

Evaluation of lymph node ratio and lymph node yield as prognosticators of locoregional recurrence in p16‐associated oropharyngeal squamous cell carcinoma

“…However, data regarding LNR in the setting of OPSCC and HPV are limited and controversial. Some studies suggest that LNR is a robust prognosticator for both HPV+ and HPV− OPSCC 25,26 while another suggest that LNR is only useful in HPV‐negative OPSCC 27 . Additionally, a well‐defined cutoff for LNR has yet to be well established in the setting of OPSCC when stratified for HPV status.…”

Lymph Node Ratio in HPV‐Associated Oropharyngeal Cancer: Identification of a Prognostic Threshold

“…DISCUSSION An often cited strength of LNR is that it incorporates both surgical and sampling factors, thus giving insight into the quality of surgical dissection, the quality of histopathological analysis, and the extent of tumor growth patterns. 8,18,25,26 Previous studies assess LNR without controlling for potential inconsistencies from heterogeneity in surgical technique, anatomic subsite, and biological underpinning of disease (i.e., HPV-positive vs. HPVnegative disease). [25][26][27][28] Our study reports LNR in HPVrelated OPSCC and examines the validity of these findings in patients treated surgically with transoral robotic surgery.…”

“…8,18,25,26 Previous studies assess LNR without controlling for potential inconsistencies from heterogeneity in surgical technique, anatomic subsite, and biological underpinning of disease (i.e., HPV-positive vs. HPVnegative disease). [25][26][27][28] Our study reports LNR in HPVrelated OPSCC and examines the validity of these findings in patients treated surgically with transoral robotic surgery. Of note, LNR has been shown to be important in predicting disease-free and overall survival (OS) in squamous cell carcinoma from other head and neck subsites.…”