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. 2020 Jul;130(7):E423-E435.
doi: 10.1002/lary.28344. Epub 2019 Nov 1.

Predictors of Mortality in HPV-Associated Oropharynx Carcinoma Treated With Surgery Alone

Mary Han  1   2 , Gaelen B Stanford-Moore  1 , Andrew R Larson  1 , David W Schoppy  3 , David M Cognetti  4 , Arjun S Joshi  5 , Jeffery J Houlton  6 , William R Ryan  3
Affiliations

Predictors of Mortality in HPV-Associated Oropharynx Carcinoma Treated With Surgery Alone

Mary Han et al. Laryngoscope. 2020 Jul.

Abstract

Objective: Survival outcomes for human papillomavirus-associated oropharynx squamous cell carcinoma (HPV + OPSCC) treated with surgery alone are unclear. To increase understanding, we assessed overall survival (OS) outcomes using the national cancer database (NCDB).

Methods: We conducted a retrospective analysis of OS of 736 NCDB HPV + OPSCC patients who underwent surgery alone from 2010 to 2014 using univariate and multivariate analyses and the Kaplan-Meir method.

Results: Multivariable analysis found the following independent risk factors for death: American Joint Commission on Cancer (AJCC) 8th edition pathologic stage(p)N2 versus pN0 disease (hazard ratio [HR], 5.5; P = 0.000006), macroscopic extranodal extension (ENE) versus non-ENE (HR, 4.9; P < 0.02), a positive lymph nodes (LN) percentage of ≥10% (HR, 4.2; P = 0.0002), and five or more positive LNs (HR, 4.9; P = 0.00004). Three-year OS was significantly worse for AJCC 8th edition pN2 versus pN0 but not for 7th edition pN2 versus pN0 disease. Five-year OS was significantly worse for positive versus negative surgical margins, AJCC 8th edition stage II versus I, and either microscopic or macroscopic ENE versus non-ENE positive LNs. For 523 (71%) AJCC 8th edition stage I patients and for 283 (38%) patients who were pT1-T2, with negative margins, pN0-N1, with ≤4 pathologic LNs, without ENE, and with >20 LNs removed during neck dissection, the 3-year OS rates were 93% and 95%, respectively, and the 5-year OS rates were 91% and 95%, respectively.

Conclusion: In the context of the lack of detail and possible inaccuracies found in the NCDB, surgery alone for AJCC 8th edition stage I HPV + OPSCC, particularly pT1-T2, pN0-N1 with ≤4 pathologic LNs, without ENE, and with negative surgical margins has a high OS.

Level of evidence: 4 Laryngoscope, 130:E423-E435, 2020.

Keywords: National Cancer Database; human papilloma virus; neck; neck dissection; oropharyngeal carcinoma; oropharynx; oropharynx cancer; overall survival; risk factors for death; surgery alone.

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References

BIBLIOGRAPHY

    1. Taberna M, Mena M, Pavon MA, Alemany L, Gillison ML, Mesía R. Human papillomavirus-related oropharyngeal cancer. Ann Oncol 2017;28:2386-2398.
    1. Goodman MT, Saraiya M, Thompson TD, et al. Human papillomavirus genotype and oropharynx cancer survival in the United States of America. Eur J Cancer 2015;51:2759-2767.
    1. Ljokjel B, Lybak S, Haave H, Olofsson J, Vintermyr OK, Aarstad HJ. The impact of HPV infection on survival in a geographically defined cohort of oropharynx squamous cell carcinoma (OPSCC) patients in whom surgical treatment has been one main treatment. Acta Otolaryngol 2014;134:636-645.
    1. Ang KK, Harris J, Wheeler R, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 2010;363:24-35.
    1. Maxwell JH, Grandis JR, Ferris RL. HPV-associated head and neck cancer: unique features of epidemiology and clinical management. Annu Rev Med 2016;67:91-101.

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