The prognostic impact of level I lymph node involvement in oropharyngeal squamous cell carcinoma

Head Neck. 2019 Nov;41(11):3895-3905. doi: 10.1002/hed.25927. Epub 2019 Aug 30.

Abstract

Background: We investigated the impact of level I lymph node involvement (LNI) on survival for patients with oropharyngeal squamous cell carcinoma (OPSCC).

Methods: We performed a cohort study of patients with OPSCC who underwent resection with known human papillomavirus (HPV) status in the National Cancer Database (2010-2014).

Results: Among 5591 patients with OPSCC, 599 (10.7%) had level I LNI. Predictors of level I LNI included pT classification (pT3 vs pT1; odds ratio [OR], 1.95; P < 0.001), pN classification (pN3 vs pN1; OR, 1.63; P = 0.05), and level III LNI (OR, 6.05; P < 0.001). Among included patients, 4035 had known survival status. Level I LNI predicted inferior overall survival (OS) while adjusting for covariates (HR, 1.64; P < 0.001). Subset analyses revealed association between level I LNI and inferior OS among patients with base of tongue cancer, pT/pN classification greater than 1, and HPV-negative cancer.

Conclusions: Level I LNI predicts inferior OS, particular among patients with at least pT2 or pN2 OPSCC.

Keywords: National Cancer Database; human papillomavirus; level I lymph node involvement; oropharyngeal squamous cell carcinoma; overall survival.

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell / mortality*
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / therapy
  • Cohort Studies
  • Female
  • Humans
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Oropharyngeal Neoplasms / mortality*
  • Oropharyngeal Neoplasms / pathology*
  • Oropharyngeal Neoplasms / therapy
  • Predictive Value of Tests
  • Survival Rate