Development and Assessment of a Novel Composite Pathologic Risk Stratification for Surgically Resected Human Papillomavirus–Associated Oropharyngeal Cancer

Abstract

Human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) is a distinct form of head and neck squamous cell carcinoma (HNSCC) with its own American Joint Committee on Cancer staging system. However, pathologic risk stratification for HPV+ OPSCC largely remains based on the experience with HPV-unassociated HNSCC.OBJECTIVE To compare the survival discrimination of traditional pathologic risk stratification for both HPV+ OPSCC and HPV-unassociated HNSCC and derive a novel pathologic risk stratification system for HPV+ OPSCC with improved survival discrimination. DESIGN, SETTING, AND PARTICIPANTSIn this retrospective cohort study, we used the National Cancer Database to identify 15 324 patients diagnosed with nonmetastatic HNSCC between January 1, 2010, and December 31, 2013, who were treated with upfront surgery and neck dissection. We compared traditional pathologic risk stratification for HPV+ OPSCC and HPV-unassociated HNSCC and then derived a novel pathologic risk stratification system.

Adjuvant Radiotherapy in Surgically Treated HPV-Positive Oropharyngeal Carcinoma with Adverse Pathological Features

“…Recent efforts have focused on re-stratifying traditional guideline-based risks to account for their summative risk on oncologic outcomes. Cramer and colleagues designed and assessed a novel composite risk score that stratified patients into 3 risk groups which predict significantly different outcomes based on pathological risk (5-year OS for low-, intermediate-, and high-risk: 76.2% vs. 54.5% vs. 40.9%) [ 15 ]. This analysis showed that microscopic (HR 1.66, 95%CI 1.18–2.32) and macroscopic ENE (HR 2.20, 95%CI 1.28–3.75) as well as LVI (HR 1.54, 95%CI 1.15–2.06) were associated with poor survival, however, LN4/5 and PSM were not prognostically significant in HPV-OPC on multivariate analyses.…”

“…Considering that 15–20% of patients with HPV-OPC experience disease recurrence [ 4 , 5 ], debate has emerged regarding patient selection for adjuvant radiotherapy in surgically treated HPV-OPC. Retrospective studies have revealed that adverse features in HPV-OPC may be associated with worse overall survival (OS) [ 14 , 15 ]. The National Comprehensive Cancer Network (NCCN) recommends adjuvant therapy for surgically treated HPV-OPC demonstrating AF [ 16 ].…”

“…Studies have investigated which adverse features require further management with adjuvant therapy in surgically treated HPV-OPC [ 19 , 20 , 21 , 22 ]. However, the individual role of each adverse feature on survival [ 15 ] and whether adjuvant radiotherapy improves survival in patients with adverse feature positive HPV-OPC is not well defined, especially for patients with early-stage disease that is amenable for primary surgical treatment. Taking these insights into account, in the present study we aimed to evaluate the individual prognostic effect of specific AF in HPV-OPC and to understand practice patterns for adjuvant radiotherapy and their associated outcomes in surgically treated AF-positive HPV-OPC (AF-HPV-OPC).…”

Tumor Glucose Metabolism and Its Heterogeneity on F-18 FDG PET/CT Provide Better Prognostication in Nonmetastatic Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma

“…Most studies have focused on patients managed with definitive chemoradiotherapy and showed that prognostication can be improved by incorporating advanced T stage and N stage based on nasopharyngeal cancer N categories [ 10 , 12 , 36 , 46 , 47 ]. A study explored surgically treated patients and revealed that a composite risk stratification system which includes pathologic adverse features such as lymphovascular invasion, surgical margins, extranodal extension, advanced T stage, and the number of metastatic lymph nodes improve prognostication [ 48 ]. However, these models need further validation.…”

JAMA Otolaryngology–Head & Neck Surgery—The Year in Review, 2019

“…We received 166 manuscripts associated with the 2019 American Head and Neck Society (AHNS) Annual Meeting, and with the outstanding effort by Neal Futran, MD, DMD, and the staffs of the AHNS and the JAMA Network, we were able to quickly review and publish 30 articles, 5 of which were published simultaneously with their presentation at that meeting. [1][2][3][4][5] This past year, JAMA Otolaryngology-Head & Neck Surgery experienced an increase in the number of submissions, from 1102 in 2018 to 1379 in 2019. We received 980 unsolicited original research submissions, which is an increase of 209 (27.1%) from 2018.…”