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Video

Head and Neck Surgery

(A578) Modeling the Risk of Occult Metastatic Disease in Head and Neck Cancer

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Nathan G. Sattah, BA

    Medical Student
    Duke University School of Medicine
    Durham, North Carolina, United States

    • Co-Author(s)

  • SZ

    Si Zhou, MS

    Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University, United States

  • JT

    Jesse Troy, PhD

    Associate Professor
    Department of Biostatistics & Bioinformatics, Duke University
    DURHAM, North Carolina, United States

  • TH

    Terry Hyslop, PhD

    Sidney Kimmel Cancer Center, Thomas Jefferson University, United States

  • ST

    Samantha M. Thomas, MS

    Principal Biostatistician and Manager
    Duke Cancer Institute; Department of Biostatistics & Bioinformatics, Duke University
    Durham, North Carolina, United States

  • NO

    Nosayaba Osazuwa-Peters, PhD

    Academic Researcher
    Duke University Medical Center
    Durham, North Carolina, United States

    • Senior Author(s)

  • Daniel J. Rocke, MD, JD

    Associate Professor
    Department of Otolaryngology, University of Alabama at Birmingham
    Mountain Brook, Alabama, United States

Disclosure(s):
Nathan G. Sattah, BA: No relevant relationships to disclose.
Jesse Troy, PhD: No relevant relationships to disclose.
Samantha M. Thomas, MS: No relevant relationships to disclose.
Daniel J. Rocke, MD, JD: No relevant relationships to disclose.


Introduction: Occult lymph node (LN) metastasis poses a significant threat to long-term outcomes for patients with head and neck cancer. This study estimated the risk of occult LN metastasis as a function of tumor stage and the number of LNs examined in oropharyngeal and oral cavity cancer.

Methods: Patients in the National Cancer Database (2004 to 2017) with oropharyngeal or oral tongue and floor of mouth (OTFOM) cancer were identified. A β-binomial model estimated the rate of false negative lymphadenectomy and the risk of occult metastatic disease based upon tumor stage and the number of LNs examined. Overall survival (OS) was estimated by quartile of the probability of occult lymph node disease using the Kaplan-Meier method.

Results: 13,657 patients met inclusion criteria, with 3,853 (28.2%) patients found to be node-positive, 4,883 (35.7%) were female, with mean (SD) age at diagnosis of 59 (12) years. The distribution by cancer stage in the cohort was 45.4%, 36.0%, 7.82%, 10.8% for stages T1, T2, T3, and T4 respectively.

The model suggested a 10% risk for false negative lymphadenectomy when 47 nodes were examined in both cancer groups. To limit the risk of occult LN metastasis to 10% for stages T1, T2, T3, and T4 respectively, the model estimated that 42, 40, 52, and 71 LNs should be examined for oropharyngeal cancers and 17, 39, 60, and 43 LNs for OTFOM cancers. The OS for patients in both cancer groups varied with the risk of occult LN metastasis (log-rank p < 0.001). In the oropharyngeal group, patients in the highest quartile of risk had a 10-year survival of 60.6% (95% CI 56.1 – 65.4) compared to 68.8% (95% CI 63.8 – 74.1), 67.8% (95% CI 61.8 – 74.4), and 67.9% (95% CI 61.3 – 75.3) for the third, second, and first quartiles. In the OTFOM group, patients in the highest quartile had a 10-year survival of 42.3% (95% CI 39.2 – 45.5) compared to 54.8% (95% CI 51.8 – 58.0), 60.3% (95% CI 57.2 – 63.5), and 65.3% (95% CI 62.2 – 68.5).

Conclusions: This study provides estimates for the risk of occult LN metastasis in patients with cancers of the oropharynx or the oral cavity. These results should be considered when evaluating the need for adjuvant radiation therapy to the neck.