Comparison of Survival of Patients With T-1(-2) cN(0) Oropharyngeal Cancer Treated With or Without Elective Neck Dissection

Objectives/Hypothesis This study aimed to examine the prognostic value of elective neck dissection (END) in T1-2 clinical negative cervical lymph node (cN(0)) oropharyngeal cancer (OPC) patients. Study Design An observational retrospective study. Methods This retrospective study included 845 patients diagnosed with T1-2 cN(0) OPC during 2010-2015 from Surveillance, Epidemiology, and End Results database. Univariable and multivariable Cox regression models were used to evaluate the prognostic roles of END. Furthermore, propensity score matching was used to balance the covariates between the END and observation (OBS) groups, and subgroup analyses were conducted in the matched cohorts. The primary endpoint was overall survival (OS). Results Our study showed that END was an independent prognostic factor associated with a better 3-year OS compared with OBS in human papillomavirus (HPV)-positive cohort (adjusted hazard ratio [HR], 0.464; 95% confidence interval [CI], 0.235-0.916; P = .027). However, we found no prognostic value of END in HPV-negative cohort (adjusted HR, 0.837; 95% CI, 0.535-1.310; P = .435). In the subgroup analyses, we found that younger patients (<= 65 years old) and patients with nontonsillar tumors in HPV-positive cohort were more likely to benefit from END, while patients with tonsillar tumors in HPV-negative cohort may benefit from END. Conclusions We found that patients with HPV-positive T1-2 cN(0) OPC could benefit from END in terms of OS, especially younger patients and those with nontonsillar tumors. Patients with HPV-negative T1-2 cN(0) OPC could not benefit from END in terms of OS, while those with tonsillar tumors may benefit from END. Level of Evidence 3 Laryngoscope, 2021