The following is a summary of “Patterns and distribution of regional nodal involvement and recurrence in a surgically treated oropharyngeal squamous cell carcinoma cohort at a tertiary center,” published in the November 2023  issue of Oncology by Abdel-Halim, et al.

For a study, researchers sought to look into and explain the trends of spread and recurrences in the area after surgery for oropharyngeal squamous cell cancer (OPSCC). The study looked back at people who were identified with OPSCC at a major referring center from 2006 to 2021. Patients who had surgery that included a neck incision were the only ones who were included. People who had head and neck cancer before, tumors in other parts of the body, or both head and neck cancer at the same time were not allowed to participate. There were a total of 928 cases. 

The age range was 25.2 to 87.5 years, and 89% of the people were men. Of those people, 513 (55.3%) had tonsil cancer. Most of the time, level II (85.2%), level III (33.3%), and level IV (9.4%) were involved in cN+ patients when they were first diagnosed. In cN0 patients, metastases were only seen in 16.2% of level II patients and 9.2% of level III patients. 48 (5.2%) of the patients had a nodal return after an average of one year (interquartile range: 0.6–2.0 years). 5% of HPV(+) patients and 7% of HPV(-) patients had nodal return, which is the same (P = 0.44). 

It happened most often at ipsilateral level II (45.8% of cases), contralateral level II (43.8%), and ipsilateral level V (25.0%). A multivariable study showed that pN was a strong predictor for return in the same area (P = 0.02). There was no difference between HPV(+) and HPV(-) OPSCC patients in how regional tumors and recurrences are spread. It is well known that regional tumors usually show up in the bilateral level II–IV at appearance. The results supported this idea. Also, the results backed up the doctor’s advice that cN0 patients should only have voluntary neck dissection on levels IIa and III on the same side, excluding level IIb. The pN state was strongly linked to regional recurrence.

Source: sciencedirect.com/science/article/abs/pii/S1368837523002658