Faculty Collaboration Database

Oncologic outcomes of selective neck dissection in HPV-related oropharyngeal squamous cell carcinoma. Laryngoscope 2017 Mar;127(3):623-630

Date

09/17/2016

Pubmed ID

27634021

DOI

10.1002/lary.26272

Scopus ID

2-s2.0-84992597790 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

OBJECTIVES: To examine outcomes of selective neck dissection (SND) in patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) who present with clinical neck disease.

STUDY DESIGN: Multi-institutional retrospective review.

METHODS: Two institutional databases of patients with HPV-related OPSCC were reviewed to identify patients with clinical (c) N1-N3 neck disease who underwent SND ± adjuvant therapy.

RESULTS: Three hundred and twenty-four patients were identified with a median follow-up of 49 months (range 3-199 months). All patients underwent transoral resection of the primary tumor and SND, including levels II-IV and ± levels I or V, with resection of additional nonlymphatic tissue (extended SND) as indicated by extent of disease, including the spinal accessory nerve (7%), the internal jugular vein (13%), and the sternocleidomastoid muscle (8%). Two hundred and seventy (83%) patients underwent adjuvant radiation. There were 13 (4%) regional recurrences and 19 (6%) distant recurrences. Regional control following salvage was 98%. On univariable analysis, absence of radiation was associated with regional recurrence (odds ratio [OR] 9.2, 95% confidence interval [CI] 2.9-29.4). On multivariable analysis, adjuvant radiation was associated with improved disease-free survival (DFS) (OR 0.27, 95% CI 0.14-0.53) but lost significance for overall (OS) and disease-specific survival (DSS) (P > 0.05). Five-year Kaplan-Meier estimates for OS, DSS, and DFS were 88% (95% CI 84%-92%), 93% (95% CI 89%-96%), and 83% (95% CI 78%-87%), respectively.

CONCLUSION: In HPV-related OPSCC presenting with clinical neck disease, a SND ± additional tissue resection and adjuvant therapy, when indicated, provides excellent long-term regional control. Omission of radiotherapy increases the risk of regional recurrence, although it may not significantly impact OS or DSS. It appears unnecessary to routinely perform a comprehensive neck dissection.

LEVEL OF EVIDENCE: 4. Laryngoscope, 127:623-630, 2017.

Author List

Zenga J, Jackson RS, Graboyes EM, Sinha P, Lindberg M, Martin EJ, Ma D, Thorstad WL, Rich JT, Moore EJ, Haughey BH

Author

Joseph Zenga MD Assistant Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Cancer Care Facilities
Carcinoma, Squamous Cell
Cohort Studies
Databases, Factual
Disease-Free Survival
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Neck Dissection
Neoplasm Recurrence, Local
Oropharyngeal Neoplasms
Papillomavirus Infections
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Survival Analysis
Treatment Outcome
Tumor Virus Infections