Long‐term analysis of transorally resected p16 + Oropharynx cancer: Outcomes and prognostic factors

Sinha, Parul; Haughey, Bruce H.; Kallogjeri, Dorina; Jackson, Ryan

doi:10.1002/lary.27472

Cited by 27 publications

(49 citation statements)

References 54 publications

(134 reference statements)

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“…However, there are few studies that examine smoking status in the context of AJCC‐8 staging guidelines. Similar to other work, our results showed a negative association between higher AJCC‐8 stage and survival as well as smoking and survival in HPV‐positive disease . Unlike previous research, our study estimates the prognostic significance of smoking while adjusting for AJCC‐8 stage and looks at the combined effects of stage and smoking status.…”

Section: Discussionsupporting

confidence: 84%

Prognostic Significance of Smoking in Human Papillomavirus–Positive Oropharyngeal Cancer Under American Joint Committee on Cancer Eighth Edition Stage

et al. 2020

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Objective To determine the prognostic significance of smoking in human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (OPSCC) when considering American Joint Committee on Cancer eighth edition (AJCC‐8) stage. Study Design Retrospective cohort study. Methods Three hundred seventeen HPV‐positive OPSCC patients with known AJCC‐8 stage and smoking status (<10 or ≥10 pack‐years) seen at a tertiary center from 1997 to 2017 were studied. We used the Kaplan‐Meier method to compare 5‐year overall survival (OS) by smoking status and by clinical AJCC‐8 stage and smoking status combined. Hazard ratios (HRs) were estimated with Cox proportional hazard regression for the independent effects of smoking and AJCC‐8 stage. We also studied pathologic stage and estimated the combined effects of smoking and clinical stage. Results The ≥10 pack‐years smokers had worse 5‐year OS than <10 pack‐years smokers (93.6%; 95% confidence interval (CI): 89.7‐97.8 vs. 82.3%; 95% CI: 76.0%‐89.1%). When stratified by AJCC‐8 clinical stage, only stage I <10 pack‐years smokers (98.7%; 95% CI: 96.3%‐100.0%) had significantly better 5‐year OS than their ≥10 pack‐years (84.8%; 95% CI: 76.4%‐94.1%) counterparts. In a multivariable analysis, ≥10 pack‐years smoking was associated with increased hazard of death when adjusting for AJCC‐8 clinical (HR: 2.52; 95% CI: 1.16‐5.46) and pathologic (HR: 5.21; 95% CI: 1.47‐18.5) stage. In both analyses, stage III patients demonstrated worse survival than stage I, and smoking had greater impact at lower stages. Conclusions Smoking is a negative prognosticator in HPV‐positive OPSCC and interacts with AJCC‐8 clinical stage. It is important to understand the impact of smoking in HPV‐positive disease when considering treatment plans and deintensification trials. Level of Evidence 2b Laryngoscope, 130: 1961–1966, 2020

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Section: Discussionsupporting

confidence: 84%

Prognostic Significance of Smoking in Human Papillomavirus–Positive Oropharyngeal Cancer Under American Joint Committee on Cancer Eighth Edition Stage

et al. 2020

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“…This investigation represents the largest series of elderly patients treated with TOS for HPV‐related OPSCC. We found that patients 70 years or older have similar 3‐year disease‐specific oncologic outcomes (DSS, 94.3%; DFS, 79.3%) compared to published series analyzing younger cohorts . As expected, OS (81.5%) was lower than the 83%‐90% typically reported for HPV‐associated OPSCC, secondary to 21.3% dying of unrelated causes .…”

Section: Discussionsupporting

confidence: 75%

“…We found that patients 70 years or older have similar 3‐year disease‐specific oncologic outcomes (DSS, 94.3%; DFS, 79.3%) compared to published series analyzing younger cohorts . As expected, OS (81.5%) was lower than the 83%‐90% typically reported for HPV‐associated OPSCC, secondary to 21.3% dying of unrelated causes . Our analysis of these data demonstrated that elderly adults with HPV‐associated OPSCC could be subcategorized into three groups, allowing us to describe a clinically relevant decrement in 3‐year OS from 100% to 54% with rising age, ACE‐27 comorbidity score, and cT stage.…”

Section: Discussionsupporting

confidence: 70%

Multi‐institutional analysis of outcomes following transoral surgery for HPV‐positive oropharyngeal squamous cell carcinoma in elderly patients

et al. 2019

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Background The incidence of human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (OPSCC) is rising, even in elderly patients. The outcomes of transoral surgery (TOS) in this population are not entirely known. Methods A retrospective review was performed at two institutions from October 2003 to September 2016 on patients 70 years or older with HPV‐related OPSCC treated with TOS. Results A total of 75 patients were included with a mean age of 74 years (70‐87 years). At a median follow‐up of 35.7 months, 3‐year overall survival was 81.5% and disease‐specific survival was 94.3%. Advanced cT stage (odds ratio, 2.74; 95% confidence interval, 1.13‐6.64) negatively impacted OS. Conjunctive consolidation was performed to create a staging system with patients older than 80 years, severe comorbidity, and cT3‐4 having worse survival. Conclusions Elderly patients with HPV‐related OPSCC treated with TOS have excellent survival and therefore should not be excluded from such therapy based on age alone.

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“…The few studies to date that have characterized recurrence-associated factors specifically in HPV-OPC have identified primary tumor category, lymph node category, and tobacco use. 4,23,[29][30][31] High-risk disease features known to be prognostic for RFS in HPV-negative HNSCC but of unclear prognostic significance in HPV-OPC include primary tumor resection margin status, LVI, PNI, and ENE. [32][33][34][35][36] Combinations of these clinicopathologic factors are currently in place to stratify risk in deintensification studies.…”

Section: Discussionmentioning

confidence: 99%

Tumor‐infiltrating lymphocyte quantification stratifies early‐stage human papillomavirus oropharynx cancer prognosis

et al. 2019

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Objectives/Hypothesis To evaluate if a simple method for assessing tumor‐infiltrating lymphocytes (TIL) in primary tumor specimens improves the prognostic value of the American Joint Committee on Cancer, 8th Edition (AJCC8) cancer staging system in human papillomavirus–positive oropharyngeal squamous cell carcinoma (HPV‐OPC). Study Design Retrospective study. Methods In this study, TIL density was quantified on hematoxylin and eosin (H&E)–stained specimens from patients presenting to Johns Hopkins Hospital between 2009 and 2017 who underwent primary surgical therapy and had primary tumor specimens available for analysis. The prognostic effect of TIL density was evaluated by Kaplan‐Meier method and Cox proportional hazards models considering recurrence‐free survival (RFS) as the primary outcome. Results This study included 132 patients. Ninety‐five percent were classified by clinical criteria with AJCC8 early‐stage disease (stage I: 82%, stage II: 13%). After 84 months of follow‐up, 15 recurrences were observed. Among clinically early‐stage disease, TILhigh status was associated with improved RFS compared to TILlow (P = .002). Adjusted analysis showed TILhigh status was associated with 79% lower risk of recurrence than TILlow (adjusted hazard ratio [aHR]: 0.210, 95% confidence interval [CI]: 0.061‐0.723). In clinical stage I disease, TILhigh status was associated with improved RFS compared to TILlow in both univariate and multivariate analyses (hazard ratio: 0.235, P = .021; aHR: 0.218; 95% CI: 0.058‐0.822). TIL density similarly stratified risk in pathologically staged disease. Conclusions In patients with AJCC8 stage I disease, low TIL density was associated with diminished RFS. Our data suggest that assessing TIL density on H&E‐stained primary tumor specimens may enhance the prognostic resolution of the AJCC8 staging criteria for HPV‐OPC. Level of Evidence 4 Laryngoscope, 130:930–938, 2020

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Long‐term analysis of transorally resected p16 + Oropharynx cancer: Outcomes and prognostic factors

Cited by 27 publications

References 54 publications

Prognostic Significance of Smoking in Human Papillomavirus–Positive Oropharyngeal Cancer Under American Joint Committee on Cancer Eighth Edition Stage

Prognostic Significance of Smoking in Human Papillomavirus–Positive Oropharyngeal Cancer Under American Joint Committee on Cancer Eighth Edition Stage

Multi‐institutional analysis of outcomes following transoral surgery for HPV‐positive oropharyngeal squamous cell carcinoma in elderly patients

Tumor‐infiltrating lymphocyte quantification stratifies early‐stage human papillomavirus oropharynx cancer prognosis

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