Impact of contralateral lymph nodal involvement and extranodal extension on survival of surgically managed HPV-positive oropharyngeal cancer staged with the AJCC eighth edition

• Published in: Oral oncology Vol. 99; p. 104447
• Main Authors: Miccio, Joseph A., Verma, Vivek, Kelly, Jacqueline, Kann, Benjamin H., An, Yi, Park, Henry S., Eskander, Antoine, Burtness, Barbara, Husain, Zain
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2019
• Subjects: AJCC 8th edition; Extranodal extension; Hematology, Oncology, and Palliative Medicine; Human papillomavirus; Lymph nodes; Oropharyngeal cancer; Otolaryngology; Staging; Survival; LN; RPA; OS; Staging; HPV + OPSCC; CI; AJCC 8th edition; Extranodal extension; HR; OPSCC; Survival; Lymph nodes; HPV; Human papillomavirus; Oropharyngeal cancer; AJCC; NCDB; ENE; LVI; human papilloma virus mediated oropharyngeal squamous cell carcinoma; National Cancer Database; oropharyngeal squamous cell carcinoma; overall survival; American joint committee on cancer; human papilloma virus; lymphovascular invasion; lymph node; Recursive Partitioning Analysis; hazard ratio; confidence interval
• ISSN: 1368-8375; 1879-0593; 1879-0593
• DOI: 10.1016/j.oraloncology.2019.104447

[Display omitted] •Contralateral pLN+ is not associated with survival in surgically-managed HPV + OPSCC.•ENE is associated with worse survival in HPV + OPSCC.•ENE should be considered in future pathologic staging systems for HPV + OPSCC. Contralateral lymph node (LN) involvement is a prognostic factor in clinical staging of oropharyngeal squamous cell carcinoma (OPSCC), while pathologic nodal staging in the AJCC 8th edition for human papillomavirus-mediated OPSCC (HPV + OPSCC) focuses exclusively on the number of involved LNs (pLN+). This study assessed if the presence of contralateral pLN+ adds prognostic importance to the number of pLN+. The National Cancer Database was queried for pLN+ HPV + OPSCC treated with surgery with 10 or more LN dissected. Data were evaluated with Cox regression, propensity score matching (PSM), and Kaplan-Meier overall survival (OS) analysis. Of 3407 patients, 152 (4.5%) patients had contralateral pLN+. Subjects with contralateral pLN+ had higher pT/pN stage, more positive margins, extranodal extension (ENE), and lymphovascular invasion (LVI) (all p < 0.05). On univariate analysis, contralateral pLN+ trended toward worse OS (HR 1.58, 95% CI 0.98–2.55, p = 0.061). In the multivariable model (controlling for age, comorbidities, T-stage, N-stage, LN size, ENE, LVI, margin status and adjuvant therapy), LN laterality had no impact on OS (HR 0.87, 95% CI 0.52–1.45, p = 0.520). Further PSM analysis confirmed that contralateral pLN+ is not associated with OS in this population (HR 0.79, 95% CI 0.41–1.53, p = 0.494). This study supports the AJCC 8th edition pathologic staging for HPV + OPSCC by observing that LN laterality is not associated with OS. ENE was associated with inferior OS and should be considered for future staging systems. Further study should be directed at the importance of nodal size in this population.