Radiographic nodal prognostic factors in stage I HPV‐related oropharyngeal squamous cell carcinoma

Abstract

Background

The updated AJCC Cancer Staging Manual groups all p16‐positive oropharyngeal squamous cell carcinoma (OPSCC) with unilateral nodal involvement within 6 cm into the new clinical N1 classification, consolidating a heterogeneous group of disease with varying radiographic findings.

Methods

A central radiological review was conducted identifying 233 patients with stage I node‐positive (cT1‐2N1) disease who underwent definitive concurrent chemoradiation. Factors evaluated included lymph node size, low‐neck lymphadenopathy, retropharyngeal lymphadenopathy, overt radiographic extracapsular extension, and matted lymphadenopathy.

Results

On multivariate analysis adjusted for age, smoking history, and chemotherapy regimen, low‐neck lymphadenopathy (hazard ratio (HR) = 6.55; P < .001) and retropharyngeal lymphadenopathy (HR = 3.36; P = .009) predicted for inferior progression‐free survival (PFS). low‐neck lymphadenopathy (HR = 6.38; P = .001) and retropharyngeal lymphadenopathy (HR = 3.32; P = .02) also predicted for inferior overall survival (OS). All other radiographic characteristics showed no prognostic impact for PFS or OS.

Conclusions

This analysis suggests that caution should be advised against de‐intensification efforts among patients with stage I node‐positive p16‐positive OPSCC with low‐neck lymphadenopathy or retropharyngeal lymphadenopathy.

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