Clinical Outcomes of Radiologically Node-Negative Oropharyngeal Squamous Cell Carcinoma: A Retrospective Analysis.

Abstract

Oropharyngeal squamous cell carcinoma (OPSCC) shows distinct clinical patterns based on HPV status. In the UK, rising HPV-positive cases have changed the disease's demographics and prognosis. While nodal involvement is a key prognostic factor, a subset presents with radiologically node-negative (N0) disease, where optimal management is unclear. This study examines survival outcomes in these patients, stratified by HPV status. A retrospective analysis of 1001 OPSCC cases (2012-2020) identified 249 N0 patients. After excluding 39 with unknown HPV status, 210 cases (37% HPV-positive) were analyzed. Demographic, clinical, and treatment data were assessed, with survival analyzed using Kaplan-Meier curves. Overall survival was 56.2%, significantly higher in HPV-positive patients (75.3% vs. 45.1%, p < 0.001). HPV-negative patients had a smaller tumor size, were more often female, with higher smoking, alcohol use, and deprivation. Despite earlier T-stage, they had worse performance scores and received surgery or supportive care more often. HPV negative OPSCC retains poor prognosis even in node-negative OPSCC and smaller tumor size on presentation.