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Comparative Study
. 2015 Sep;37(9):1246-53.
doi: 10.1002/hed.23740. Epub 2015 Jul 4.

Oropharyngeal squamous cell carcinoma in the veteran population: Association with traditional carcinogen exposure and poor clinical outcomes

Vlad C Sandulache  1 , John Hamblin  1 , Syeling Lai  2   3 , Todd Pezzi  1 , Heath D Skinner  4 , Numan A Khan  1 , Shayan M Dioun  1 , Christine Hartman  5 , Jennifer Kramer  5 , Elizabeth Chiao  5 , Xiaodong Zhou  6 , Jose P Zevallos  1
Affiliations
Comparative Study

Oropharyngeal squamous cell carcinoma in the veteran population: Association with traditional carcinogen exposure and poor clinical outcomes

Vlad C Sandulache et al. Head Neck. 2015 Sep.

Abstract

Background: A significant fraction of oropharyngeal squamous cell carcinoma (SCC) cases is associated with traditional carcinogens; in these patients, treatment response and clinical outcomes remain poor.

Methods: We evaluated patient, tumor, and treatment characteristics for 200 veterans with oropharyngeal SCC treated at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) between 2000 and 2012.

Results: Most patients (77%) were white and heavy smokers. Twenty-seven patients required tracheostomy and 63 required gastrostomy placement during treatment. Overall survival (OS) at 5 years was 40%. Survival was impacted by T classification, treatment intensity, completion of treatment, and p16 tumor status. Almost 30% of patients were unable to complete a treatment regimen consistent with National Comprehensive Cancer Network (NCCN) guidelines.

Conclusion: Oropharyngeal SCC in veterans is associated with traditional carcinogens and poor clinical outcomes. Despite heavy smoking exposure, p16 tumor status significantly impacts survival. Careful consideration must be given to improving treatment paradigms for this cohort given their limited tolerance for treatment escalation.

Keywords: gastrostomy; oropharyngeal cancer; smoking; tracheostomy; veteran.

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Conflict of interest statement

None of the authors have any relationships that they believe could be construed as resulting in an actual, potential, or perceived conflict of interest with regard to the manuscript submitted for review.

Figures

Figure 1
Figure 1. Patient survival
OPSCCA overall survival (OS) (A) and disease free survival (DFS) (B). Effect of T stage on OS (C) and DFS (D).
Figure 2
Figure 2. Treatment effect (overall survival)
Patients which received curative intent treatment had better survival compared to patients which did not (A). The addition of chemotherapy (B) and completion of the entire treatment regimen (C) was also associated with improved overall survival.
Figure 3
Figure 3. Treatment effect (disease free survival)
Patients which received curative intent treatment had better survival compared to patients which did not (A). The addition of chemotherapy (B) and completion of the entire treatment regimen (C) was also associated with improved disease free survival.
Figure 4
Figure 4. p16 effect. All patients with p16 data were analyzed
P16 positive tumors were associated with significantly improved overall (A) and disease free survival (B).
See this image and copyright information in PMC

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