Human Papillomavirus–Associated Oropharyngeal Cancer: Patterns of Nodal Disease

Karolina A. Plonowska, Madeleine P. Strohl, Steven J. Wang, Patrick K. Ha, Jonathan R. George, Chase M. Heaton, Ivan H. El-Sayed, Jon Mallen-St. Clair, William R. Ryan

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Objective: To characterize patterns of neck lymph node (LN) metastases in human papillomavirus (HPV)–associated oropharyngeal squamous cell carcinoma, represented by p16 positivity (p16+OPSCC). Study Design: Case series with chart review. Setting: Tertiary care center. Subjects and Methods: Neck dissection (ND) specimens of nonirradiated p16+OPSCC patients were analyzed for frequencies of clinically evident and occult LNs by neck level. Local, regional, and distant recurrences were reviewed. Results: Seventy p16+OPSCC patients underwent primary site transoral robotic surgery and 82 NDs of varying levels. Metastatic pathologic LNs were found at the following frequencies: 0% (0/28) in level I, 75.6% (62/82) in level II with 57.4% (35/61) in level IIA and 13.1% (8/61) in level IIB, 22.0% (18/82) in level III, 7.0% (5/71) in level IV, and 6.3% (1/16) in level V. The level V LN was clinically evident preoperatively. Five of 21 (23.8%) elective NDs contained occult LNs, all of which were in level II and without extranodal extension. Twenty-seven (38.6%) patients underwent adjuvant radiation; 19 (27.1%) patients underwent adjuvant chemoradiation. With a mean follow-up of 29 months, 3 patients had developed recurrences, with all but 1 patient still alive. All patients who recurred had refused at least a component of indicated adjuvant treatment. Conclusions: For p16+OPSCC, therapeutic NDs should encompass any levels bearing suspicious LNs and levels IIA-B, III, and IV, while elective NDs should be performed and encompass at least levels IIA-B and III. These selective ND plans, followed by indicated adjuvant treatment, are associated with a low nodal recurrence rate.

Original languageEnglish (US)
Pages (from-to)502-509
Number of pages8
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number3
StatePublished - Mar 1 2019


  • human papillomavirus (HPV)
  • lymph node metastases
  • neck dissection
  • oropharynx
  • p16
  • squamous cell carcinoma

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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