title: Outcomes of surgically treated human papillomavirus-related oropharyngeal squamous cell carcinoma with N3 disease.
abstract: To evaluate outcomes for patients with pathological N3 (pN3) neck disease from human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) and determine variables predictive of survival.
  
  
  
  Retrospective case series with chart review.
  
  
  
  This study was conducted between 1998 and 2013 and included patients with HPV-related OPSCC treated with surgery with or without adjuvant therapy and who had pN3 nodal disease. The primary outcome was disease-specific survival (DSS). Secondary outcomes included overall survival (OS), disease-free survival (DFS), adverse events, and gastrostomy tube rates.
  
  
  
  Thirty-nine patients were included, of whom 36 (90%) underwent adjuvant therapy. Median follow-up was 39 months (range, 2-147 months). Mean age was 56 years, and 87% were male. Seventeen patients (44%) underwent selective neck dissection, whereas six (15%) underwent radical (n = 2) or extended radical (n = 4) neck dissection. Ninety-two percent had extracapsular extension. Five-year Kaplan-Meier estimated DSS, OS, and DFS were 89% (95% confidence interval [CI]: 79%-99%), 87% (95% CI: 75%-99%), and 84% (95% CI: 72%-96%), respectively. The disease recurrence rate was 10% (5% regional, 5% distant metastasis). Patients with less than 5 pathologically positive lymph nodes (P = .041) had improved DFS.
  
  
  
  Patients with HPV-related OPSCC and pN3 nodal disease treated with surgery and adjuvant therapy have very favorable long-term survival and regional control. Patients with five or more pathologically positive lymph nodes may be at higher risk for recurrence.
  
  
  
  4. Laryngoscope, 127:2033-2037, 2017.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, Missouri, U.S.A.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zenga
authors.affiliation: Department of Surgery, University of Auckland Faculty of Medicine, Auckland, New Zealand.|Head and Neck Surgery Center of Florida, Celebration Hospital, Celebration, Florida, U.S.A.
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Haughey
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, Missouri, U.S.A.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Jackson
authors.affiliation: Department of Medical Oncology, Washington University, St. Louis, Missouri, U.S.A.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Adkins
authors.affiliation: Department of Surgical Pathology, Washington University, St. Louis, Missouri, U.S.A.
authors.forename: John
authors.initials: J
authors.lastname: Aranake-Chrisinger
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, Missouri, U.S.A.
authors.forename: Neel
authors.initials: N
authors.lastname: Bhatt
authors.affiliation: Department of Radiation Oncology, Washington University, St. Louis, Missouri, U.S.A.
authors.forename: Hiram A
authors.initials: HA
authors.lastname: Gay
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, Missouri, U.S.A.
authors.forename: Dorina
authors.initials: D
authors.lastname: Kallogjeri
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 Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Moore
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, Missouri, U.S.A.
authors.forename: Randal C
authors.initials: RC
authors.lastname: Paniello
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, Missouri, U.S.A.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Rich
authors.affiliation: Department of Radiation Oncology, Washington University, St. 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, St. Louis, Missouri, U.S.A.
authors.forename: Brian
authors.initials: B
authors.lastname: Nussenbaum
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery* / Q000821:virology; D017024:Chemotherapy, Adjuvant / Q000379:methods / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D005774:Gastrostomy / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery* / Q000821:virology; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000473:pathology / Q000601:surgery / Q000821:virology; D037981:Neck Dissection / Q000379:methods / Q000401:mortality*; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications* / Q000601:surgery / Q000821:virology; D011184:Postoperative Period; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Oropharyngeal neoplasms; human papillomavirus; squamous cell carcinoma