Background: Pathologic extracapsular extension (ECE) in lymph nodepositive head and neck squamous cell carcinoma leads to poor prognosis. However, the prognostic utility of ECE in human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) is less certain. Methods: Retrospective analysis was performed on patients who underwent surgery for primary HPV-related OPSCC and received adjuvant radiotherapy (RT) between 2006 and 2015. Locoregional control (LRC), distant control (DC), progression-free survival (PFS) and overall survival (OS) were compared between the groups with and without ECE using univariate Kaplan-Meier and multivariate Cox regression survival analyses. Results: 75 patients were identified and ECE was demonstrated on the surgical pathology of 26 patients. Patient/tumor characteristics of those with ECE were similar to those without ECE, except for ECE(+) patients more frequently receiving concurrent chemotherapy (76.9% vs. 32.7%; p<0.0001) and RT doses >66 Gy (76.9% vs. 16.3%; p<0.001). With a median follow-up of 29 months, patients with ECE had a significantly worse 5-year DC rate than those without ECE (76.7% vs. 97.9%; p Z 0.046), and patients with ECE had a significantly worse 5-year PFS (54.5% vs. 93.6%; p Z 0.021) than those without ECE, despite more patients in the ECE(+) cohort receiving concurrent chemotherapy. On multivariate Cox regression analysis, ECE was independently prognostic of worse DC (hazard ratio: 8.26; 95% confidence interval: 1.24d55.21; p Z 0.029) and worse PFS (HR: 4.64; 95% CI: 1.18d18.29; p Z 0.028). There was no statistically significant difference in 5-year LRC (93.3% vs. 95.7%) or OS (66.9% vs. 97.0%) between ECE(+) and ECE(-) patients, respectively. Conclusion: This study suggests that ECE is independently prognostic of worse DC and PFS in patients who undergo surgery prior to adjuvant RT for primary HPV-related OPSCC compared to those without ECE, but that LRC and OS are similar.
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