Predictors and Prevalence of Nodal Disease in Salvage Oropharyngectomy
Authors: A J Rosko
C R Bradford
J C Brenner
K A Casper
C L Stucken
A G Shuman
S B Chinn
M E Spector
J S Moyer
G T Wolf
J Brennan
S A McLean
D B Chepeha
K M Malloy
M E P Prince
M E Heft Neal
Journal: Annals of surgical oncology (2020)
Discipline: CLINICAL MEDICINE
Keywords: recurrent oropharyngeal cancer; salvage surgery; neck dissection; nodal disease; oropharyngectomy
Affiliations: Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA., Head and Neck Surgical Oncology and Reconstructive Microsurgery, Department of Otolaryngology, Department of Surgical Oncology, University of Toronto, Toronto, ON, USA., Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA. .

Abstract:  Background: Patients with recurrent oropharyngeal cancer often require extensive salvage surgery. For patients with clinically N0 necks, the indication for concurrent neck dissection remains unclear. This study aimed to determine predictors, prevalence, and distribution of nodal disease in patients treated with salvage oropharyngectomy. Methods: In a case series with data collection at a single tertiary academic National Cancer Institute (NCI)-designated comprehensive cancer center, this study analyzed patients treated with prior radiation or chemoradiation who had persistent, recurrent, or second primary squamous cell carcinoma of the oropharynx requiring oropharyngeal resection between 1998 and 2017 (n = 95). Clinical and oncologic characteristics and treatment outcomes were collected, and statistical analyses were performed. Results: The overall rate of nodal positivity was 21% (24/95), and the rate of occult nodal disease was 6% (4/65). Ipsilateral and contralateral level 2 were the most common areas harboring positive nodes. Bivariate analysis showed female sex (p = 0.01), initial overall stage (p = 0.02), and N status (p = 0.03), as well as recurrent overall and T stage (p = 0.05) to be predictors of nodal disease. In the multivariate analysis, recurrent T stage continued to be significantly predictive of pathologic nodal disease. Both computed tomography (CT) and positron emission tomography-CT were moderately accurate in predicting nodal disease in the salvage setting (area under the curve, 0.79 and 0.80, respectively). Conclusion: Occult nodal disease is observed in few patients undergoing salvage oropharyngeal resection. This study identified factors predictive of nodal disease in patients undergoing salvage oropharyngectomy and appropriate diagnostic tests in this setting. 

Retracted: No

PubPeer comments:
 In the first paragraph of Results, the statement u201cIn clinically node negative (cN0) patients, the rate of pathologically positive nodal disease was found to be 6% (n=4 65), whereas in clinically node positive (cN+) patients, the rate of pathologically positive nodal disease was 67% (n=20 30)u201d is not consistent with the data presented in Table 2. Could anyone explain this to me? , 
 The highlighted sentences in the first paragraph of the results do not match with the data in Tables 1 and 2. And in table 2 pN+ column, N=24 was indicated, but some clinical characteristics of this column do not add up to 24.    ,