Predictors of contralateral‐bilateral nodal disease in oropharyngeal cancer: A National Cancer Data Base Study

Background Oropharyngeal squamous cell carcinoma (SCC) frequently presents with cervical metastasis. Roles of human papillomavirus (HPV) status, among other factors, on laterality are elusive. Methods The National Cancer Database was reviewed for oropharyngeal SCC diagnosed from 2010‐2014. Predictors of clinically evident contralateral or bilateral nodal disease were identified. Results A total of 15 517 patients with oropharyngeal SCC met criteria. The majority was HPV‐positive. Histologically poorly differentiated tumors were more frequent in the HPV‐positive group (55.7% vs 37.6%; P < .001). By incidence, there was no statistical difference in contralateral or bilateral nodal disease between HPV‐positive and HPV‐negative patients (14.2% vs 14.5%, respectively; P = .769). On multivariable analysis, notable predictors of contralateral or bilateral nodal disease included HPV‐positivity (odds ratio [OR] 1.26; 99% confidence interval [CI] 1.10‐1.44), base of tongue (BOT) location (OR 2.15; 99% CI 1.88‐2.45), poorly differentiated tumor (OR 1.72; 99% CI 1.20‐2.46), and T4 classification (OR 6.65; 99% CI 5.34‐8.28). Conclusion Patients with HPV‐associated oropharyngeal SCC have increased likelihood of contralateral or bilateral nodal disease. Tumor grade, tumor location, and tumor size are also independent predictors.