title: Residual nodal disease in patients with advanced-stage oropharyngeal squamous cell carcinoma treated with definitive radiation therapy and posttreatment neck dissection: Association with locoregional recurrence, distant metastasis, and decreased survival.
abstract: BACKGROUND
  Oropharyngeal squamous cell carcinoma (OPSCC) is increasing in frequency. We reviewed patients with advanced-stage OPSCC treated with chemoradiation to assess the impact of residual neck disease on survival.
  
  
  METHODS
  We reviewed 202 patients with OPSCC between 1990 and 2010 treated with primary chemoradiation followed by neck dissection. Imaging was analyzed using RECIST (Response Evaluation Criteria In Solid Tumors) 1.1 criteria. Survival was evaluated using both univariate and multivariate analyses.
  
  
  RESULTS
  Overall survival at 5 years was 89%. Forty-two patients (21%) had residual disease in the neck (pN+). pN+ was associated with greater locoregional recurrence (LRR) and distant metastasis (DM) and decreased survival. No clinicopathologic factors were predictive of pN+. Contrasted posttreatment CT had low sensitivity and specificity.
  
  
  CONCLUSIONS
  In advanced OPSCC pN+, patients have higher rates of LRR and DM. Neither clinicopathologic factors nor posttreatment imaging was predictive of pN+, although increased use of modern imaging may reduce the rate of negative neck dissections.
authors.affiliation: Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Vlad C
authors.initials: VC
authors.lastname: Sandulache
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Ow
authors.forename: Shiva P
authors.initials: SP
authors.lastname: Daram
authors.forename: Jackson
authors.initials: J
authors.lastname: Hamilton
authors.forename: Heath
authors.initials: H
authors.lastname: Skinner
authors.forename: Diana
authors.initials: D
authors.lastname: Bell
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.forename: Beth M
authors.initials: BM
authors.lastname: Beadle
authors.forename: K Kian
authors.initials: KK
authors.lastname: Ang
authors.forename: Merrill S
authors.initials: MS
authors.lastname: Kies
authors.forename: Faye M
authors.initials: FM
authors.lastname: Johnson
authors.forename: Adel K
authors.initials: AK
authors.lastname: El-Naggar
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Myers
mesh_terms: D000328:Adult; D000368:Aged; D002173:Cancer Care Facilities; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D037981:Neck Dissection / Q000379:methods / Q000401:mortality; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013781:Texas; D016896:Treatment Outcome