Patients with oropharyngeal squamous cell carcinoma who had "matted" lymph nodes -- nodes that are connected together -- are more likely to metastasize than those without matted lymph nodes, according to a study published online in the journal Head & Neck
Metastases account for about 45% of the deaths among patients with oropharyngeal carcinoma, wrote Douglas B. Chepeha, MD, MPH, an associate professor of Otolaryngology Head and Neck Surgery at the University of Michigan Medical School in Ann Arbor.
"Our findings may help doctors identify patients who are at higher risk for having their cancer metastasize and who would benefit from additional systemic therapy," he said, adding that the opposite was also true -- those without matted nodes might benefit from reducing therapy.
The researchers tracked 78 patients who were part of a clinical trial evaluating 2 cancer drugs with intensity-modulated radiation therapy. All of the treatment-naive patients had stage III-IV squamous cell carcinoma of the oropharynx. Sixteen of the 78 patients had matted nodes. They found that patients with matted nodes had a 69% survival rate over 3 years, compared with 94% for patients without matted nodes.
The risk was independent of other prognostic factors, such as the patient's history of smoking, alcohol use, or human papillomavirus (HPV) infection.
Matted nodes appear to be an especially strong indicator of increased risk among patients who are HPV-positive. However, HPVpositive patients had better overall outcomes than HPV-negative patients did. The patients with the best outcomes were HPV-positive nonsmokers, but Matthew E. Spector, MD, a head and neck surgery resident at the University of Michigan, said the reasons are unclear.