title: Incidence of contralateral-bilateral nodes in the human papillomavirus era.
abstract: HPV-positive oropharyngeal squamous cell carcinoma has a more favorable prognosis when compared to HPV-negative disease, regardless of the presence of nodal metastases. However, the importance of contralateral neck treatment based on HPV status has not been well studied. Given the historically poor prognostic implications of cervical nodal metastases, this study sought to elucidate the relationship between HPV status and contralateral/bilateral nodal metastasis in patients with oropharyngeal squamous cell carcinoma.
  
  
  
  Retrospective cohort analysis.
  
  
  
  Data were collected on patients with oropharyngeal squamous cell carcinoma from 2001 to 2014. Nodal status was determined by contrast-enhanced computed tomography, positron emission tomography, or surgical pathology when available. Survival rates and associations between HPV status and demographic/tumor characteristics were assessed.
  
  
  
  Of 178 total patients, 46 (26.0%) had contralateral/bilateral metastases. There was no significant difference in incidence of contralateral/bilateral nodal metastases between HPV-positive and HPV-negative patients (24.6% vs. 29.1%, P = .53). Tonsil primaries had significantly lower incidence of contralateral/bilateral nodal metastases compared to tongue base (20.9% vs. 34.3%, P = .048). On multivariate regression, tumor size was the only factor associated with contralateral/bilateral nodal metastases (T4 vs. T1-3 odds ratio = 5.15, 95% confidence interval: 2.4-11.2). Five-year overall survival among all patients with and without contralateral/bilateral nodal metastases was 45.4% and 65.2%, respectively (P = .007).
  
  
  
  Our results did not show a significantly different incidence of contralateral/bilateral nodal metastases between HPV-positive and HPV-negative patients. T4 stage and tongue base location, however, were associated with contralateral disease. These data suggest treatment of bilateral necks might be warranted in these cases, regardless of HPV status.
  
  
  
  4 Laryngoscope, 127:1328-1333, 2017.
authors.affiliation: Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, U.S.A.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Tritter
authors.affiliation: Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, U.S.A.|Department of Surgery, Overton-Brooks VA Medical Center, Shreveport, Louisiana, U.S.A.
authors.forename: Vikas
authors.initials: V
authors.lastname: Mehta
authors.affiliation: Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, U.S.A.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Samuelson
authors.affiliation: School of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, U.S.A.
authors.forename: Ginger
authors.initials: G
authors.lastname: deGravelle
authors.affiliation: Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, U.S.A.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, U.S.A.
authors.forename: Tara
authors.initials: T
authors.lastname: Medlin-Moore
authors.affiliation: Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, U.S.A.
authors.forename: Amol
authors.initials: A
authors.lastname: Takalkar
authors.affiliation: School of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, U.S.A.
authors.forename: Gloria
authors.initials: G
authors.lastname: Caldito
authors.affiliation: Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, U.S.A.|Department of Surgery, Overton-Brooks VA Medical Center, Shreveport, Louisiana, U.S.A.
authors.forename: Cherie-Ann O
authors.initials: CO
authors.lastname: Nathan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000821:virology; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000821:virology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009333:Neck / Q000473:pathology / Q000821:virology; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000821:virology; D027383:Papillomaviridae; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate
keywords: N2c; Squamous cell carcinoma; bilateral; contralateral; head and neck cancer; human papillomavirus; nodal metastases; oropharynx; tongue base; tonsil