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Prognostic value of the lymph node ratio in oropharyngeal carcinoma stratified for HPV-status

  • Head and Neck
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Abstract

Objective

Lymph node ratio (LNR) was shown to be a prognostic factor in laryngeal and oral cavity primaries. The purpose of this study was to investigate the impact of the lymph node ratio in oropharyngeal squamous cell carcinoma (OPSCC) with a high incidence of HPV-related disease. Therefore, the role of LNR was evaluated as an additional predictive parameter to the 8th edition of AJCC TNM staging system.

Methods

From December 2009 to August 2015, patients diagnosed with primary oropharyngeal squamous cell carcinoma were prospectively enrolled. After tumor resection with uni- or bilateral neck dissection, patients with ≥ 1 nodal metastasis (pN+) were eligible for a retrospective LNR analysis.

Results

137 patients underwent tumor resection with uni- or bilateral neck dissection. The proportion of HPV-associated disease was 42%. Most patients (n = 96; 70%) presented with involved neck nodes. In p16-positive OPSCC, the rate of pN + cases was significantly increased compared to p16-negative OPSCC (86% vs. 58%, p = 0.007). Patients with LNR ≤ 10% had a significant better overall survival (OS) and disease-specific survival (DSS). However, when stratified for p16-status, LNR ≤ 10% had a significant impact on OS only for HPV-associated tumors (p = 0.027), whereas LNR of ≤ 10% was not a significant predictor for better OS in p16-negative OPSCC (p = 0.143).

Conclusion

The LNR with a cut-off value of 10% serves as an additional prognostic parameter in HPV-related OPSCC and may help to improve risk stratification in combination with the revised AJCC 8th edition TNM classification.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany

    Christian Jacobi, Josepha Rauch, Thomas Lautz, Maximilian Reiter & Philipp Baumeister

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Johannes-Gutenberg-University Medical Center, Langenbeckstraße 1, Mainz, 55131, Germany

    Jan Hagemann

  3. Clinical Cooperation Group Personalized Radiotherapy in Head and Neck Cancer, Helmholtz Center, Munich, Germany

    Philipp Baumeister

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  1. Christian Jacobi
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Correspondence to Christian Jacobi.

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The study was approved the ethical standards of the institutional research committee and conducted in accordance to the principles of the Declaration of Helsinki (1964).

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Jacobi, C., Rauch, J., Hagemann, J. et al. Prognostic value of the lymph node ratio in oropharyngeal carcinoma stratified for HPV-status. Eur Arch Otorhinolaryngol 275, 515–524 (2018). https://doi.org/10.1007/s00405-017-4833-z

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