Parul Sinha1, Dorina Kallogjeri2, Hiram Gay3, Wade L Thorstad3, James S Lewis4, Rebecca Chernock4, Brian Nussenbaum1, Bruce H Haughey5. 1. Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States. 2. Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States; Clinical Outcomes Research, Washington University School of Medicine, St. Louis, MO, United States. 3. Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States. 4. Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States; Pathology, Washington University School of Medicine, St. Louis, MO, United States. 5. Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States. Electronic address: haugheyb@ent.wustl.edu.
Abstract
BACKGROUND: Due to unique biology and prognosis, precise identification of predictive parameters is critical for p16+ oropharyngeal squamous cell carcinoma (OPSCC). Prior studies showing absence of prognostication from extracapsular spread (ECS) and/or high N-classification in surgically-treated p16+ OPSCC necessitate new, evidence-based prognosticators. METHODS: A prospectively assembled cohort of 220, transoral surgery+neck dissection±adjuvant therapy-treated, p16+ OPSCC patients was analyzed. Disease recurrence and disease-specific survival (DSS) were primary endpoints. RESULTS: Median follow-up was 59 (12-189) months. Distribution of metastatic node numbers was: 0 in 9.5% (n=21), 1 in 33.6% (n=74), 2 in 17% (n=38), 3 in 14.5% (n=32), 4 in 8.2% (n=18), and ⩾5 in 17% (n=37). ECS was recorded in 80% (n=159), and N2c-N3 in 17% (n=38). Adjuvant radiotherapy and chemoradiotherapy was administered in 44% and 34%. Recurrence developed in 22 patients (10%); 4 local, 5 regional, 2 regional and distant, and 11 distant. The 3- and 5-year DSS estimates were 94.6% and 93%. Multivariable logistic regression identified ⩾5 nodes and T3-T4 classification as predictors for recurrence. In multivariable Cox analyses, ⩾5 nodes, T3-T4 classification and margins were prognostic for DSS. ECS, N2c-N3 classification and smoking were not prognostic. CONCLUSIONS: Metastatic node number, not ECS or high N-classification is an independent nodal predictor of outcomes in surgically-treated p16+ OPSCC patients. Despite high DSS (~80%), closer surveillance for recurrence is recommended for patients with ⩾5 metastatic nodes.
BACKGROUND: Due to unique biology and prognosis, precise identification of predictive parameters is critical for p16+ oropharyngeal squamous cell carcinoma (OPSCC). Prior studies showing absence of prognostication from extracapsular spread (ECS) and/or high N-classification in surgically-treated p16+ OPSCC necessitate new, evidence-based prognosticators. METHODS: A prospectively assembled cohort of 220, transoral surgery+neck dissection±adjuvant therapy-treated, p16+ OPSCC patients was analyzed. Disease recurrence and disease-specific survival (DSS) were primary endpoints. RESULTS: Median follow-up was 59 (12-189) months. Distribution of metastatic node numbers was: 0 in 9.5% (n=21), 1 in 33.6% (n=74), 2 in 17% (n=38), 3 in 14.5% (n=32), 4 in 8.2% (n=18), and ⩾5 in 17% (n=37). ECS was recorded in 80% (n=159), and N2c-N3 in 17% (n=38). Adjuvant radiotherapy and chemoradiotherapy was administered in 44% and 34%. Recurrence developed in 22 patients (10%); 4 local, 5 regional, 2 regional and distant, and 11 distant. The 3- and 5-year DSS estimates were 94.6% and 93%. Multivariable logistic regression identified ⩾5 nodes and T3-T4 classification as predictors for recurrence. In multivariable Cox analyses, ⩾5 nodes, T3-T4 classification and margins were prognostic for DSS. ECS, N2c-N3 classification and smoking were not prognostic. CONCLUSIONS: Metastatic node number, not ECS or high N-classification is an independent nodal predictor of outcomes in surgically-treated p16+ OPSCC patients. Despite high DSS (~80%), closer surveillance for recurrence is recommended for patients with ⩾5 metastatic nodes.
Authors: M Reuschenbach; S Wagner; N Würdemann; S J Sharma; E-S Prigge; M Sauer; A Wittig; C Wittekindt; M von Knebel Doeberitz; J P Klussmann Journal: HNO Date: 2016-07 Impact factor: 1.284
Authors: Somiah Siddiq; David Cartlidge; Sarah Stephen; Hans P Sathasivam; Hannah Fox; James O'Hara; David Meikle; Muhammad Shahid Iqbal; Charles G Kelly; Max Robinson; Vinidh Paleri Journal: Eur Arch Otorhinolaryngol Date: 2018-05-12 Impact factor: 2.503
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Authors: B H Haughey; P Sinha; D Kallogjeri; R L Goldberg; J S Lewis; J F Piccirillo; R S Jackson; E J Moore; M Brandwein-Gensler; S J Magnuson; W R Carroll; T M Jones; M D Wilkie; A Lau; N S Upile; Jon Sheard; J Lancaster; S Tandon; M Robinson; D Husband; I Ganly; J P Shah; D M Brizel; B O'Sullivan; J A Ridge; W M Lydiatt Journal: Oral Oncol Date: 2016-09-23 Impact factor: 5.337