title: Patterns of nodal metastasis and prognosis in human papillomavirus-positive oropharyngeal squamous cell carcinoma.
abstract: BACKGROUND
  The current American Joint Committee on Cancer (AJCC) staging system may not accurately reflect survival in patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (SCC). The purpose of this study was to develop a system that more precisely predicts survival.
  
  
  METHODS
  CT scans from 156 patients who underwent chemoradiation for advanced-stage oropharyngeal SCC with >2 years follow-up were reviewed. We modeled patterns of nodal metastasis associated with different survival rates. We defined HPV+ N1 as a single node <6 cm, ipsilaterally, contralaterally, or bilaterally. HPV+ N2 was defined as a single node ≥6 cm or ≥2 nodes ipsilaterally/contralaterally or ≥3 nodes bilaterally. HPV+ N3 was defined as matted nodes.
  
  
  RESULTS
  There was no significant difference in disease-specific survival (DSS; p = .14) or overall survival (OS; p = .16) by AJCC classification. In patients grouped by HPV+ N1, HPV+ N2, and HPV+ N3 nodal classification, significant differences in DSS (100%, 92%, and 55%, respectively; p = .0001) and OS (100%, 96%, and 55%, respectively; p = .0001) were found.
  
  
  CONCLUSIONS
  A staging system with reclassification of size, bilaterality, and matted nodes more accurately reflects survival differences in this cohort of patients. Review of the AJCC staging system with these criteria should be considered for HPV-positive oropharyngeal SCC.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan.
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: Bellile
authors.forename: Steven B
authors.initials: SB
authors.lastname: Chinn
authors.forename: Mohannad
authors.initials: M
authors.lastname: Ibrahim
authors.forename: Serena
authors.initials: S
authors.lastname: Byrd
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Chanowski
authors.forename: Heather M
authors.initials: HM
authors.lastname: Walline
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: Jonathan B
authors.initials: JB
authors.lastname: McHugh
authors.forename: Kitrina
authors.initials: K
authors.lastname: Cordell
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: D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000556:secondary* / Q000821:virology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D009959:Oropharyngeal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000821:virology; D030361:Papillomavirus Infections / Q000401:mortality* / Q000473:pathology*; D011379:Prognosis; D015996:Survival Rate
keywords: American Joint Committee on Cancer Staging System; human papillomavirus; matted nodes; nodal metastasis; oropharyngeal squamous cell carcinoma
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