Abstract
Human papillomavirus-related oropharyngeal squamous cell carcinoma is associated with cystic lymph nodes on CT and has a favorable prognosis. A subset of patients with aggressive disease experience treatment failure. Our aim was to determine whether the extent of cystic lymph node burden on staging CT can serve as an imaging biomarker to predict treatment failure in human papillomavirus-related oropharyngeal squamous cell carcinoma. We identified patients with human papilloma virus-related oropharyngeal squamous cell carcinoma and staging neck CTs. Demographic and clinical variables were recorded. We retrospectively classified the metastatic lymph node burden on CT as cystic or solid and assessed radiologic extracapsular spread. Biopsy, subsequent imaging, or clinical follow-up was the reference standard for treatment failure. The primary end point was disease-free survival. Cox proportional hazard regression analyses of clinical, demographic, and anatomic variables for treatment failure were performed. One hundred eighty-three patients were included with a mean follow-up of 38 months. In univariate analysis, the following variables had a statistically significant association with treatment failure: solid-versus-cystic lymph nodes, clinical T-stage, clinical N-stage, and radiologic evidence of extracapsular spread. The multivariate Cox proportional hazard model resulted in a model that included solid-versus-cystic lymph nodes, T-stage, and radiologic evidence of extracapsular spread as independent predictors of treatment failure. Patients with cystic nodal metastasis at staging had significantly better disease-free survival than patients with solid lymph nodes. In human papilloma virus-related oropharyngeal squamous cell carcinoma, patients with solid lymph node metastases are at higher risk for treatment failure with worse disease-free survival. Solid lymph nodes may serve as an imaging biomarker to tailor individual treatment regimens.
Highlights
BACKGROUND AND PURPOSEHuman papillomavirus–related oropharyngeal squamous cell carcinoma is associated with cystic lymph nodes on CT and has a favorable prognosis
In human papilloma virus–related oropharyngeal squamous cell carcinoma, patients with solid lymph node metastases are at higher risk for treatment failure with worse disease-free survival
Human papillomavirus (HPV)–related oropharyngeal squamous cell carcinoma (OPSCC) is a distinct disease with more favorable locoregional control and survival outcomes compared with HPV-unrelated OPSCC.[1,2,3]
Summary
Our aim was to determine whether the extent of cystic lymph node burden on staging CT can serve as an imaging biomarker to predict treatment failure in human papillomavirus–related oropharyngeal squamous cell carcinoma. The purpose of this study was to determine whether solid and cystic lymph node metastases on staging neck CT could be used as an imaging biomarker to predict TF in patients with stage III or IV HPV-related OPSCC. The goal of our study was to evaluate the prognostic value of the extent of cystic metastatic lymph node burden at staging for the prediction of TF in patients with stage III and IV (HPV)-related OPSCC
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