In OPSCC, Tumor Location and T Stage More Significant than HPV Status

Is there a difference in the incidence of contralateral/bilateral lymph node metastases (CBNM) for human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) when compared with HPV-negative OPSCC?

Bottom line
There was no significantly different incidence of CBNM between HPV-positive and HPV-negative patients. T4 stage and tongue base location, however, were associated with contralateral disease.

Background: Recent investigations have shown anywhere from 25% to 70% of OPSCCs to be associated with HPV, with more than 90% of these being caused by the high-risk HPV16 genotype. Irrespective of the presence of nodal metastases, HPV-positive OPSCC has been shown to have a better prognosis than HPV-negative disease, likely related to a better response to treatment.

Study design: Retrospective cohort analysis of 178 patients with oropharyngeal squamous cell carcinoma from Jan. 1, 2001, to April 30, 2014.

Setting: Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Science Center, Shreveport.

Synopsis: In the group, 46 patients had CBNM. Sixty-two patients had disease recurrence or persistence, and 71 died during the follow-up period. There were no instances of contralateral recurrence where the contralateral neck was originally determined to be free of disease, or of disease progression to the contralateral neck. There was no significant difference in CBNM incidence between HPV-positive and HPV-negative patients. Tumor primary site was a significant CBNM predictor, lower among patients with primary tumors of the tonsil compared to patients with primary tumors of the base of tongue or other posterior oropharynx sites. Patients with T4 tumors had higher CBNM incidence than those with T1, T2, or T3 tumors. Patients with stage IV disease had higher CBNM incidence than those with stage I, II, or III. Both presence of CBNM and HPV status had significant influence as individual variables on both three- and five-year overall survival and disease-specific survival. Limitations included the investigation’s retrospective nature, the use of PET/CT as the principle means of determining nodal stage, and use of p16 in isolation to determine HPV status.

Citation: Tritter AG, Mehta V, Samuelson M. Incidence of contralateral–bilateral nodes in the human papillomavirus era. Laryngoscope. 2017;127:1328–1333.