Long-term survival and swallowing outcomes in advanced stage oropharyngeal squamous cell carcinomas

Abstract

BackgroundThere is a paucity of studies reporting long-term survival outcomes for HPV/p16 positive oropharyngeal squamous cell carcinoma (OPSCC). This study aims to compare long-term outcomes of advanced stage p16 positive and negative OPSCCs, treated by surgical and non-surgical modalities.MethodsOPSCC patients from 1998 to 2012 were identified through a prospectively collected cancer registry. P16 immunohistochemistry was used as a surrogate marker for HPV-OPSCC. Overall survival (OS) and aspiration free survival (AFS) comparisons were made between patients treated with chemoradiation (CRT) versus primary surgery and radiation/chemoradiation (S+RT/CRT) at 5, 10 and 15 years post-treatment.ResultsA total of 319 patients were included. P16 positive patients and non-smokers had significantly higher long-term (5, 10 and 15-year) OS. Smokers and p16 negative patients treated with S+RT/CRT had improved long-term OS compared to patients who received CRT. Smokers and p16 negative patients had lower long-term AFS. Multivariate analysis showed improved OS was associated with p16 positivity (HR 0.42, 0.28–0.61) and surgery (HR 0.47, 0.32–0.69), whereas lower OS was associated with ECOG ≥ 2 (HR 2.46, 1.61–3.77), smoking (HR 2.37, 1.41–3.99) and higher stage (HR 1.68, 1.05–2.68).ConclusionsIn smokers and p16-negative OPSCC patients, primary surgery may be associated with improved long-term survival and dysphagia-related outcomes.

Association of human papillomavirus related squamous cell carcinomas of the oropharynx and cervix

“…HPV+ve OPSCC strikingly differs from HPV-ve OPSCC from clinical, pathologic and molecular perspectives [[8], [9], [10], [11]]. Its implications affect staging, prognosis and treatment modalities [12,13].…”

Macrophages expressing TREM-1 are involved in the progression of HPV16-related oropharyngeal squamous cell carcinoma

“…TREM-1 and CD68 infiltration are also reciprocally correlated, however, none of the two markers is significantly associated to CD4 and CD8 infiltration. These points may configure a gap and deserve a comment: in a retrospective study on a database of 7731 cases, a high frequency (30.2%) of clinic-pathological stage discrepancy has been demonstrated in OP-SCCs [ 35 ]; in another study on 319 cases, long-term survivals in patients with advanced-stage have been also reported [ 36 ]. An interpretation of these events may be that the biological interference of HPV has influenced the relationships between tumour cells and its background: for these reasons, the pathological staging of OP-SCCs has been subjected to a radical revision in view of the last TNM edition [ 37 ], where HPV-related and non-related tumours have been separated.…”

Transoral Robotic Surgery Versus Chemoradiation Treatment in Oropharyngeal Cancer: Case-matched Comparison of Survival and Swallowing Outcomes

“…Survival outcomes appear to be comparable with higher rates of aspiration and gastrostomy tube dependence in those treated with RT/CRT. Treatment with TORS alone has been seen to result in superior outcomes by avoiding the toxic effects of RT/CRT (10,22,26,30,31).…”

“…HPV-OPSCC is often seen in younger, otherwise healthy patients in which excellent survival rates can be achieved but this outcome measure is inadequate. Patient-centered treatments must be tailored to minimize swallowing impairment and its impact on a patient's quality of life (10). When considering both survival and function, a lack of comparative studies has left equipoise regarding the optimal treatment for OPSCC (11)(12)(13).…”