Predictors of contralateral-bilateral nodal disease in oropharyngeal cancer: A National Cancer Data Base Study

Head Neck. 2018 Feb;40(2):338-348. doi: 10.1002/hed.24964. Epub 2017 Sep 30.

Abstract

Background: Oropharyngeal squamous cell carcinoma (SCC) frequently presents with cervical metastasis. Roles of human papillomavirus (HPV) status, among other factors, on laterality are elusive.

Methods: The National Cancer Database was reviewed for oropharyngeal SCC diagnosed from 2010-2014. Predictors of clinically evident contralateral or bilateral nodal disease were identified.

Results: A total of 15 517 patients with oropharyngeal SCC met criteria. The majority was HPV-positive. Histologically poorly differentiated tumors were more frequent in the HPV-positive group (55.7% vs 37.6%; P < .001). By incidence, there was no statistical difference in contralateral or bilateral nodal disease between HPV-positive and HPV-negative patients (14.2% vs 14.5%, respectively; P = .769). On multivariable analysis, notable predictors of contralateral or bilateral nodal disease included HPV-positivity (odds ratio [OR] 1.26; 99% confidence interval [CI] 1.10-1.44), base of tongue (BOT) location (OR 2.15; 99% CI 1.88-2.45), poorly differentiated tumor (OR 1.72; 99% CI 1.20-2.46), and T4 classification (OR 6.65; 99% CI 5.34-8.28).

Conclusion: Patients with HPV-associated oropharyngeal SCC have increased likelihood of contralateral or bilateral nodal disease. Tumor grade, tumor location, and tumor size are also independent predictors.

Keywords: National Cancer Data Base; human papillomavirus; lymph node metastasis; oropharynx; squamous cell carcinoma.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / secondary*
  • Carcinoma, Squamous Cell / virology
  • Databases, Factual
  • Female
  • Humans
  • Lymphatic Metastasis*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • National Cancer Institute (U.S.)
  • Neck
  • Neoplasm Grading
  • Oropharyngeal Neoplasms / mortality
  • Oropharyngeal Neoplasms / pathology*
  • Oropharyngeal Neoplasms / virology
  • Papillomaviridae* / isolation & purification
  • Papillomavirus Infections / complications*
  • Registries
  • Risk Factors
  • Survival Analysis
  • United States