The relevance of the lymph node ratio as predictor of prognosis is higher in HPV-negative than in HPV-positive oropharyngeal squamous cell carcinoma

Abstract

Objectives

Lymph node ratio (LNR) is an established predictor in different entities of carcinoma, including head and neck malignancies. In oropharyngeal squamous cell carcinoma (OPSCC), lymph node involvement differs between Human Papilloma Virus (HPV)-positive and negative tumours. Herein, we evaluate the impact of HPV association on the concept of LNR.

Methods

88 surgically treated patients were included in this retrospective chart review. HPV-positive and negative OPSCC were evaluated for prediction of outcome by LNR separately. The endpoints were five-year overall survival (OS) and recurrence free survival (RFS).

Results

The OS of all patients was 60.1%. In univariate analysis LNR was a significant predictor of overall survival rate (p=0.008) in OPSCC independently of the HPV status, as well as extracapsular spread. T-classification was only a significant predictor in the univariate analysis in HPV-positive OPSCC carcinoma. However, in the multivariate analysis LNR remained predictor of prognosis in all OPSCC and in HPV-negative OPSCC. In patients with HPV-positive OPSCC only T-classification reached significance to predict OS.

Conclusion

Prognosis of primarily operated HPV-positive patients might be more dependent on the extent of primary tumour site, whereas prognosis of HPV-negative patients is based more on cervical metastatic spread, represented by LNR.

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