Outcomes of surgically treated human papillomavirus–related oropharyngeal squamous cell carcinoma with <scp>N</scp>3 disease

Zenga, Joseph; Haughey, Bruce H.; Adkins, Douglas R.; Chrisinger, John S.A.; Bhatt, Neel K.; Kallogjeri, Dorina; Martin, Eliot J.; Moore, Eric J.; Paniello, Randal C.; Rich, Jason T.; Thorstad, Wade L.; Nussenbaum, Brian

doi:10.1002/lary.26455

Cited by 8 publications

(17 citation statements)

References 31 publications

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“…This study represents one of the very few studies of patients with p16‐positive N3 OPSCC . In our series, patients had a 5‐year OS of 67.5%, so relatively good outcomes as compared to previously published survival of patients with a p16‐negative N3 disease (Table ).…”

Section: Discussionsupporting

confidence: 53%

“…However, the rates of oropharyngeal localizations among series of N3 have been ranging from 13% for Chan et al, to 76% for Adams et al, depending on the country and the date . Results from more recent studies are somehow very divergent regarding treatment outcomes specifically in OPSCC . The obvious reason for this shift of prognostic is the worldwide increasing incidence of papillomavirus‐associated p16‐positive OPSCC, which present more often with an advanced lymph node staging but yield better survival rates as compared to tobacco‐ and alcohol‐induced disease .…”

Section: Discussionmentioning

confidence: 99%

“…In fact, the incidence of OPSCC is steadily rising in most of the developed countries, related to oncogenic human papillomavirus (HPV) infection, and HPV‐related OPSCC have demonstrated a comparatively better prognosis than tobacco‐driven lesions . Yet, a few publications on N3 head and neck cancer have focused on patients with OPSCC, and only 2 of these series have reported the survival rates of patients with a p16‐positive N3 OPSCC . Hence, the prognosis factors associated with survival and treatment outcomes in patients with p16‐positive N3 OPSCC remain largely unknown.…”

Section: Introductionmentioning

confidence: 99%

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Smoking and papillomavirus DNA in patients with p16‐positive N3 oropharyngeal squamous cell carcinoma

et al. 2018

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Background We investigated the survival of patients with a p16‐positive N3 oropharyngeal squamous cell carcinoma (OPSCC) and the prognostic significance of patient, tumor, and treatment characteristics. Methods We retrospectively reviewed the data of patients treated at our Cancer Center for a p16‐positive N3 OPSCC between 2003 and 2016. End points were overall survival (OS) and progression‐free survival (PFS). Results A total of 29 patients were included. The 5‐year OS and PFS were 67.5% and 59.1%, respectively. Smoking history above 10 pack‐years and the absence of human papillomavirus DNA were associated with worse OS (P = .02 and P = .03, respectively) and PFS (P = .02 and P = .02, respectively). Induction chemotherapy or radical neck dissection were not associated with different treatment outcomes. Conclusion Patients with an N3 p16‐positive oropharyngeal cancer in our series had a 5‐year OS rate of 67.5%. Smoking history and viral DNA were prognostic factors associated with survival.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Smoking and papillomavirus DNA in patients with p16‐positive N3 oropharyngeal squamous cell carcinoma

et al. 2018

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“…7 Several studies 6,8 have reported that the previous edition of the AJCC staging manual (AJCC-7) could not reliably fulfill the prognostic needs of HPV-positive patients. Additional studies 8,27 about HPV-positive patients with OPSCC found that the AJCC-7 pT stage was significantly associated with survival, but the nN stage was not. A recent study 27 from the Washington University School of Medicine found that pN3 cases were equivalent to N1 cases and pN1 was associated with better survival than pN0.…”

Section: Discussionmentioning

confidence: 99%

Defining the Prevalence and Prognostic Value of Perineural Invasion and Angiolymphatic Invasion in Human Papillomavirus–Positive Oropharyngeal Carcinoma

Albergotti

Schwarzbach

Abberbock

et al. 2017

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Recently, the American Joint Committee on Cancer (AJCC) updated its staging system for human papillomavirus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC). The prognostic significance of perineural invasion (PNI) and angiolymphatic invasion (ALI) within this staging system is unknown. OBJECTIVE To examine the prevalence and prognostic significance of PNI and ALI in HPV-positive OPSCC. DESIGN, SETTING, AND PARTICIPANTS A retrospective review was performed of all patients with HPV-positive OPSCC treated surgically at the University of Pittsburgh Medical Center from January 1, 1980, through December 31, 2015, with at least 1 year of follow-up or death within 1 year. INTERVENTIONS Surgical treatment of HPV-positive OPSCC. MAIN OUTCOMES AND MEASURES The prevalence of PNI and ALI was determined from review of pathologic data, and Kaplan-Meier curves were generated for overall survival and disease-free survival when stratified by the presence of PNI and ALI. Multivariate analysis was performed using a Cox proportional hazards regression model. RESULTS A total of 201 patients met the inclusion criteria (mean [SD] age, 57.4 [9.0] years; 79.6% [3.0%] male, and 20.4% [3.0%] female). Perineural invasion was identified in 32 of 201 primary specimens (15.9%), whereas ALI was identified in 74 of 201 primary specimens (36.8%). Both were significantly associated with increasing T stage. On multivariate analysis, the presence of at least 1 risk factor was significantly associated with overall and disease-free survival (overall hazard ratio, 2.78; 95% CI, 1.15–6.76; disease-free survival hazard ratio, 3.10; 95% CI, 1.17–8.23). Among patients classified as having stage II disease according to the eighth edition of the AJCC manual, the presence of at least 1 risk factor was associated with worse overall survival (hazard ratio, 11.7; 95% CI, 1.2–111.7). CONCLUSIONS AND RELEVANCE Both PNI and ALI were commonly found in HPV-positive OPSCC, with increasing prevalence as T stage increased. The presence of at least 1 risk factor was associated with worse overall and disease-free survival. Specifically, among patients classified as having stage II disease according to the eighth edition of the AJCC manual, the presence of ALI or PNI may suggest a poorer prognosis.

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“…Further, in a recent multivariable analysis investigating prognostic factors in patients with HPV‐related oropharyngeal SCC after definitive chemoradiation, N3 classification was the single most significant risk factor for locoregional failure . In a recent review of patients with N3 neck disease from HPV‐related oropharyngeal SCC managed with primary surgery and adjuvant therapy, however, the regional recurrence rate was only 5% . Nonetheless, the resectability of the nonsurgical cases is uncertain and comparisons are confounded by unknown variables.…”

Section: Discussionmentioning

confidence: 99%

Oncologic outcomes of extended neck dissections in human papillomavirus‐related oropharyngeal squamous cell carcinoma

et al. 2018

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Patients with invasive nodal disease from HPV-related oropharyngeal SCC can be managed with up-front surgery and adjuvant therapy, as indicated with good regional control. Although distant recurrence was the primary site of failure, adjuvant chemotherapy was not associated with improved outcomes. The T classification, node number, and adjuvant radiotherapy are independent prognostic factors in this patient population.

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Outcomes of surgically treated human papillomavirus–related oropharyngeal squamous cell carcinoma with N3 disease

Abstract: 4. Laryngoscope, 127:2033-2037, 2017.

Cited by 8 publications

References 31 publications

Smoking and papillomavirus DNA in patients with p16‐positive N3 oropharyngeal squamous cell carcinoma

Smoking and papillomavirus DNA in patients with p16‐positive N3 oropharyngeal squamous cell carcinoma

Defining the Prevalence and Prognostic Value of Perineural Invasion and Angiolymphatic Invasion in Human Papillomavirus–Positive Oropharyngeal Carcinoma

Oncologic outcomes of extended neck dissections in human papillomavirus‐related oropharyngeal squamous cell carcinoma

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