Distribution of Cervical Lymph Node Metastases From Squamous Cell Carcinoma of the Oropharynx in the Era of Risk Stratification Using Human Papillomavirus and Smoking Status.
To investigate the factors contributing to the clinical presentation of oropharyngeal squamous cell carcinoma (OPSCC) in the era of risk stratification using human papilloma virus (HPV) and smoking status.



All patients with OPSCC presenting to our institutional multidisciplinary clinic from January 2009 to June 2015 were reviewed from a prospective database. The patients were grouped as being at low risk, intermediate risk, and high risk in the manner described by Ang et al. Variance in clinical presentation was examined using χ(2), Kruskal-Wallis, Mann-Whitney, and logistic regression analyses.



The rates of HPV/p16 positivity (P<.001), never-smoking (P=.016), and cervical lymph node metastases (P=.023) were significantly higher for patients with OPSCC of the tonsil, base of tongue (BOT), or vallecula subsites when compared with pharyngeal wall or palate subsites. Low-risk patients with tonsil, base of tongue, or vallecula primary tumors presented with nodal stage N2a at a much higher than expected frequency (P=.007), and high-risk patients presented with tumor stage T4 at a much higher than expected frequency (P=.003). Patients with BOT primary tumors who were never-smokers were less likely to have clinically involved ipsilateral neck disease than were former smokers (odds ratio 1.8; P=.038). The distribution of cervical lymph node metastases was not associated with HPV/p16 positivity, risk group, or subsite. When these data were compared with those in historical series, no significant differences were seen in the patterns of cervical lymph node metastases for patients with OPSCC.



For patients with OPSCC differences in HPV status, smoking history and anatomic subsite were associated with differences in clinical presentation but not with distribution of cervical lymph node metastases. Historical series describing the patterns of cervical lymph node metastases in patients with OPSCC remain clinically relevant.
Department of Radiation Oncology, University of Louisville, Louisville, Kentucky. Electronic address: mjamsb01@louisville.edu.
Mark J
MJ
Amsbaugh
Department of Radiation Oncology, University of Louisville, Louisville, Kentucky.
Mehran
M
Yusuf
Department of Otolaryngology, University of Louisville, Louisville, Kentucky.
Elizabeth
E
Cash
Department of Radiation Oncology, University of Louisville, Louisville, Kentucky.
Craig
C
Silverman
Department of Otolaryngology, University of Louisville, Louisville, Kentucky.
Elizabeth
E
Wilson
Department of Otolaryngology, University of Louisville, Louisville, Kentucky.
Jeffrey
J
Bumpous
Department of Otolaryngology, University of Louisville, Louisville, Kentucky.
Kevin
K
Potts
Division of Medical Oncology, Department of Medicine, University of Louisville, Louisville, Kentucky.
Cesar
C
Perez
Department of Diagnostic Radiology, University of Louisville, Louisville, Kentucky.
Robert
R
Bert
Division of Medical Oncology, Department of Medicine, University of Louisville, Louisville, Kentucky.
Rebecca
R
Redman
Department of Radiation Oncology, University of Louisville, Louisville, Kentucky.
Neal
N
Dunlap
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000556:secondary* / Q000821:virology; D015897:Comorbidity; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000556:secondary* / Q000821:virology; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D009959:Oropharyngeal Neoplasms / Q000453:epidemiology* / Q000821:virology; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D000071036:Sentinel Lymph Node / Q000473:pathology / Q000821:virology; D012907:Smoking / Q000453:epidemiology*; D000077195:Squamous Cell Carcinoma of Head and Neck