Radiographic retropharyngeal lymph node involvement in HPV-associated oropharyngeal carcinoma: Patterns of involvement and impact on patient outcomes.
Adult
Aged
Aged, 80 and over
Carcinoma, Squamous Cell
/ diagnosis
Cervical Vertebrae
/ diagnostic imaging
Chemoradiotherapy
/ statistics & numerical data
Cohort Studies
Female
Head and Neck Neoplasms
/ diagnosis
Humans
Lymph Nodes
/ diagnostic imaging
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Staging
Oropharyngeal Neoplasms
/ diagnosis
Papillomavirus Infections
/ complications
Pharynx
/ diagnostic imaging
Prognosis
Retrospective Studies
Squamous Cell Carcinoma of Head and Neck
/ diagnosis
Treatment Outcome
HPV
head and neck
oropharyngeal carcinoma
radiotherapy
retropharyngeal lymph node
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
01 05 2019
01 05 2019
Historique:
received:
29
06
2018
revised:
17
10
2018
accepted:
18
10
2018
pubmed:
9
1
2019
medline:
28
1
2020
entrez:
9
1
2019
Statut:
ppublish
Résumé
The objective of the current study was to characterize the incidence, pattern, and impact on oncologic outcomes of retropharyngeal lymph node (RPLN) involvement in HPV-associated oropharyngeal cancer (OPC). Data regarding patients with HPV-associated OPC who were treated at The University of Texas MD Anderson Cancer Center with intensity-modulated radiotherapy from 2004 through 2013 were analyzed retrospectively. RPLN status was determined by reviewing pretreatment imaging and/or reports. Outcomes analysis was restricted to patients with lymph node-positive (+) disease. Kaplan-Meier survival estimates were generated and survival curves were compared using the log-rank test. Bayesian information criterion assessed model performance changes with the addition of RPLN status to current American Joint Committee on Cancer staging. Competing risk analysis compared modes of disease recurrence. The incidence of radiographic RPLN involvement was 9% (73 of 796 patients) and was found to vary by primary tumor site. The 5-year rates of freedom from distant metastases (FDM) and overall survival were lower in patients with RPLN(+) status compared with those with RPLN-negative (-) status (84% vs 93% [P = .0327] and 74% vs 87% [P = .0078], respectively). RPLN(+) status was not found to be associated with outcomes on multivariate analysis. Bayesian information criterion analysis demonstrated that current American Joint Committee on Cancer staging was not improved with the inclusion of RPLN. Locoregional and distant disease recurrence probabilities for those patients with RPLN(+) status were 8% and 13%, respectively, compared with 10% and 6%, respectively, for those with RPLN(-) status. RPLN(+) status portended worse 5-year FDM in the low-risk subgroup (smoking history of <10 pack-years) and among patients who received concurrent chemotherapy but not induction chemotherapy. RPLN(+) status was associated with worse overall survival and FDM on univariate but not multivariate analysis. In subgroup analyses, RPLN(+) status was associated with poorer FDM in both patients with a smoking history of <10 pack-years and those who received concurrent chemotherapy, suggesting that RPLN(+) status could be considered an exclusion criteria in treatment deintensification efforts seeking to omit chemotherapy.
Sections du résumé
BACKGROUND
The objective of the current study was to characterize the incidence, pattern, and impact on oncologic outcomes of retropharyngeal lymph node (RPLN) involvement in HPV-associated oropharyngeal cancer (OPC).
METHODS
Data regarding patients with HPV-associated OPC who were treated at The University of Texas MD Anderson Cancer Center with intensity-modulated radiotherapy from 2004 through 2013 were analyzed retrospectively. RPLN status was determined by reviewing pretreatment imaging and/or reports. Outcomes analysis was restricted to patients with lymph node-positive (+) disease. Kaplan-Meier survival estimates were generated and survival curves were compared using the log-rank test. Bayesian information criterion assessed model performance changes with the addition of RPLN status to current American Joint Committee on Cancer staging. Competing risk analysis compared modes of disease recurrence.
RESULTS
The incidence of radiographic RPLN involvement was 9% (73 of 796 patients) and was found to vary by primary tumor site. The 5-year rates of freedom from distant metastases (FDM) and overall survival were lower in patients with RPLN(+) status compared with those with RPLN-negative (-) status (84% vs 93% [P = .0327] and 74% vs 87% [P = .0078], respectively). RPLN(+) status was not found to be associated with outcomes on multivariate analysis. Bayesian information criterion analysis demonstrated that current American Joint Committee on Cancer staging was not improved with the inclusion of RPLN. Locoregional and distant disease recurrence probabilities for those patients with RPLN(+) status were 8% and 13%, respectively, compared with 10% and 6%, respectively, for those with RPLN(-) status. RPLN(+) status portended worse 5-year FDM in the low-risk subgroup (smoking history of <10 pack-years) and among patients who received concurrent chemotherapy but not induction chemotherapy.
CONCLUSIONS
RPLN(+) status was associated with worse overall survival and FDM on univariate but not multivariate analysis. In subgroup analyses, RPLN(+) status was associated with poorer FDM in both patients with a smoking history of <10 pack-years and those who received concurrent chemotherapy, suggesting that RPLN(+) status could be considered an exclusion criteria in treatment deintensification efforts seeking to omit chemotherapy.
Identifiants
pubmed: 30620385
doi: 10.1002/cncr.31944
pmc: PMC7443173
mid: NIHMS1617658
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1536-1546Subventions
Organisme : NCI NIH HHS
ID : P50 CA097007
Pays : United States
Organisme : NIDCR NIH HHS
ID : R01 DE025248
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA214825
Pays : United States
Organisme : NIDCR NIH HHS
ID : R56 DE025248
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA218148
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA225190
Pays : United States
Organisme : NCI NIH HHS
ID : K12 CA088084
Pays : United States
Organisme : NIBIB NIH HHS
ID : R25 EB025787
Pays : United States
Informations de copyright
© 2019 American Cancer Society.
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