Reilly A Sample1,2, Carey Burton Wood1, Angela L Mazul1,3, Thomas F Barrett1, Randal C Paniello1, Jason T Rich1, Stephen Y Kang4, Jose Zevallos1, Mackenzie D Daly5, Wade L Thorstad5, Stephanie Y Chen1, Patrik Pipkorn1, Ryan S Jackson1, Sidharth V Puram1,6. 1. Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA. 2. Clinical Research Training Center, Institute of Clinical and Translational Sciences, Washington University School of Medicine, St Louis, Missouri, USA. 3. Division of Public Health Sciences, Department of Surgery, Washington University, St Louis, Missouri, USA. 4. Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital, Solove Research Institute, The Ohio State University, Columbus, Ohio, USA. 5. Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri, USA. 6. Department of Genetics, Washington University School of Medicine, St Louis, Missouri, USA.
Abstract
BACKGROUND: For human papilloma virus positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC), management recommendations for patients with a single metastatic lymph node <6 cm in diameter remain nebulous, leading to treatment heterogeneity in this common subgroup of patients. METHODS: We utilized the National Cancer Database to perform survival and multivariable analyses of patients with HPV+ OPSCC with one positive lymph node <6 cm and negative surgical margins. RESULTS: We found that 5-year survival is comparable between patients who receive surgery and adjuvant radiation versus surgery alone. In multivariable analyses, we found no significant difference in the hazard ratio of overall survival after adjusting for various potential confounders. CONCLUSIONS: These data suggest that patients with margin-negative HPV+ OPSCC with a single positive lymph node <6 cm have comparable survival with or without adjuvant radiation. Future studies exploring outcomes for this specific group in randomized-controlled trials will be critical for further evaluating these initial observations.
BACKGROUND: For human papilloma virus positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC), management recommendations for patients with a single metastatic lymph node <6 cm in diameter remain nebulous, leading to treatment heterogeneity in this common subgroup of patients. METHODS: We utilized the National Cancer Database to perform survival and multivariable analyses of patients with HPV+ OPSCC with one positive lymph node <6 cm and negative surgical margins. RESULTS: We found that 5-year survival is comparable between patients who receive surgery and adjuvant radiation versus surgery alone. In multivariable analyses, we found no significant difference in the hazard ratio of overall survival after adjusting for various potential confounders. CONCLUSIONS: These data suggest that patients with margin-negative HPV+ OPSCC with a single positive lymph node <6 cm have comparable survival with or without adjuvant radiation. Future studies exploring outcomes for this specific group in randomized-controlled trials will be critical for further evaluating these initial observations.
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