title: Oncologic outcomes of selective neck dissection in HPV-related oropharyngeal squamous cell carcinoma.
abstract: 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.
  
  
  
  Multi-institutional retrospective review.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  4. Laryngoscope, 127:623-630, 2017.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University, Saint Louis, Missouri, U.S.A.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zenga
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University, Saint Louis, Missouri, U.S.A.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Jackson
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University, Saint Louis, Missouri, U.S.A.
authors.forename: Evan M
authors.initials: EM
authors.lastname: Graboyes
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University, Saint Louis, Missouri, U.S.A.
authors.forename: Parul
authors.initials: P
authors.lastname: Sinha
authors.affiliation: Washington University School of Medicine, Saint Louis, Missouri, U.S.A.
authors.forename: Miranda
authors.initials: M
authors.lastname: Lindberg
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Eliot J
authors.initials: EJ
authors.lastname: Martin
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ma
authors.affiliation: Department of Radiation Oncology, Washington University, Saint Louis, Missouri, U.S.A.
authors.forename: Wade L
authors.initials: WL
authors.lastname: Thorstad
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University, Saint Louis, Missouri, U.S.A.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Rich
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Moore
authors.affiliation: Head and Neck Surgery Center of Florida, Celebration Hospital, Celebration, Florida, U.S.A.|Department of Surgery, University of Auckland Faculty of Medicine, Auckland, New Zealand.
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Haughey
mesh_terms: D000328:Adult; D000368:Aged; D002173:Cancer Care Facilities; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery* / Q000821:virology; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D037981:Neck Dissection / Q000379:methods* / Q000401:mortality; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery* / Q000821:virology; D030361:Papillomavirus Infections / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000401:mortality / Q000473:pathology / Q000601:surgery
keywords: HPV; Neck dissection; oropharynx; squamous cell carcinoma