title: Matted nodes: poor prognostic marker in oropharyngeal squamous cell carcinoma independent of HPV and EGFR status.
abstract: BACKGROUND
  Despite better prognosis, there is a group of oropharyngeal squamous cell carcinoma (SCC) human papillomavirus (HPV)+ patients who experience treatment failure and succumb to distant metastasis.
  
  
  METHODS
  Seventy-eight previously untreated patients nested in a concurrent chemoradiation protocol were reviewed to correlate patterns of local-regional tumor extent to distant metastasis. Biomarker assessment was: HPV in situ hybridization and epidermal growth factor receptor (EGFR) immunointensity.
  
  
  RESULTS
  The 3-year disease-specific survival (DSS) for patients presenting with and without matted nodes was 69% and 94%, respectively (p = .003). Matted nodes were a poor prognostic factor independent of T classification, HPV, EGFR, and smoking status. For patients who were HPV+, 7 of 11 died of distant metastasis and 6 of 7 with distant metastasis had matted nodes.
  
  
  CONCLUSIONS
  Matted nodes are a novel marker of poor prognosis in oropharyngeal SCC independent of established prognostic factors. Matted nodes may identify patients at risk for the development of distant metastasis who could benefit from systemic therapy, whereas patients without matted nodes may be candidates for de-escalation of therapy.
authors.affiliation: Departments of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Spector
authors.forename: K Kelly
authors.initials: KK
authors.lastname: Gallagher
authors.forename: Emily
authors.initials: E
authors.lastname: Light
authors.forename: Mohannad
authors.initials: M
authors.lastname: Ibrahim
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Chanowski
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Moyer
authors.forename: Mark E
authors.initials: ME
authors.lastname: Prince
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Wolf
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
authors.forename: Kitrina
authors.initials: K
authors.lastname: Cordell
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: McHugh
authors.forename: Thomas
authors.initials: T
authors.lastname: Carey
authors.forename: Francis P
authors.initials: FP
authors.lastname: Worden
authors.forename: Avraham
authors.initials: A
authors.lastname: Eisbruch
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Chepeha
mesh_terms: D001964:Bromhexine; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000821:virology; D066246:ErbB Receptors / Q000378:metabolism*; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000821:virology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000821:virology; D030361:Papillomavirus Infections / Q000150:complications; D011379:Prognosis; D000077195:Squamous Cell Carcinoma of Head and Neck; D046888:Tissue Array Analysis
chemical_list: D066246:ErbB Receptors; D001964:Bromhexine