Kevin J Contrera1, Timothy D Smile2, Chengetai Mahomva3, Wei Wei4, David J Adelstein5, James R Broughman2, Brian B Burkey6, Jessica L Geiger5, Nikhil P Joshi2, Jamie A Ku6, Eric D Lamarre6, Robert R Lorenz6, Brandon L Prendes6, Joseph Scharpf6, Larisa M Schwartzman4, Neil M Woody2, David Xiong7, Shlomo A Koyfman2. 1. Head & Neck Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States. Electronic address: contrek@ccf.org. 2. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States. 3. Head & Neck Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States. 4. Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States. 5. Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States. 6. Head & Neck Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States; Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States. 7. Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States.
Abstract
INTRODUCTION: The objective of this study is to evaluate locoregional and distant failure for human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) using American Joint Committee on Cancer eighth edition (AJCC 8) staging. MATERIALS AND METHODS: Retrospective cohort study of 457 patients with HPV + OPSCC, treated with platinum-based chemoradiation from 2002 to 2018, followed for a median of 4.3 years. Time to locoregional failure (TTLRF) and distant failure (TTDF) were estimated by Kaplan-Meier method. Log-rank, recursive partitioning analysis (RPA), and multivariable Cox proportional hazards were used to evaluate associated factors and stratify risk. RESULTS: Rates of five-year locoregional control (LRC) and distant control (DC) were 92% (95% CI, 90-95%) and 89% (95% CI, 85-92%), respectively. Smoking, T4, N3, and stage III were associated with significantly worse TTLRF. RPA identified three distinct locoregional failure groups: cT1-3 and <19 pack-years vs. cT1-3 with ≥19 pack-years vs. cT4 (five-year LRC: 97% vs. 90% vs. 82%, P < .0001). The only factor associated with significantly worse TTDF was smoking status, while stage was not correlated. RPA identified two prognostic groups: former or never smokers vs. current smokers (five-year DC: 92% vs. 77%, P = .0003). DISCUSSION: In the largest evaluation of HPV + OPSCC after platinum-based chemoradiation using AJCC 8, risk for locoregional recurrence was stratified by smoking, T category, N category, and overall stage. Risk of distant recurrence was only stratified by smoking status and not related to stage. This has implications for surveillance and clinical trial design.
INTRODUCTION: The objective of this study is to evaluate locoregional and distant failure for human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) using American Joint Committee on Cancer eighth edition (AJCC 8) staging. MATERIALS AND METHODS: Retrospective cohort study of 457 patients with HPV + OPSCC, treated with platinum-based chemoradiation from 2002 to 2018, followed for a median of 4.3 years. Time to locoregional failure (TTLRF) and distant failure (TTDF) were estimated by Kaplan-Meier method. Log-rank, recursive partitioning analysis (RPA), and multivariable Cox proportional hazards were used to evaluate associated factors and stratify risk. RESULTS: Rates of five-year locoregional control (LRC) and distant control (DC) were 92% (95% CI, 90-95%) and 89% (95% CI, 85-92%), respectively. Smoking, T4, N3, and stage III were associated with significantly worse TTLRF. RPA identified three distinct locoregional failure groups: cT1-3 and <19 pack-years vs. cT1-3 with ≥19 pack-years vs. cT4 (five-year LRC: 97% vs. 90% vs. 82%, P < .0001). The only factor associated with significantly worse TTDF was smoking status, while stage was not correlated. RPA identified two prognostic groups: former or never smokers vs. current smokers (five-year DC: 92% vs. 77%, P = .0003). DISCUSSION: In the largest evaluation of HPV + OPSCC after platinum-based chemoradiation using AJCC 8, risk for locoregional recurrence was stratified by smoking, T category, N category, and overall stage. Risk of distant recurrence was only stratified by smoking status and not related to stage. This has implications for surveillance and clinical trial design.
Keywords:
American Joint Committee on Cancer; Chemotherapy; Head and neck cancer; Human papillomavirus-associated; Metastasis; Oropharyngeal; Radiation; Recurrence; Squamous cell carcinoma
Authors: Robert M Brody; David Shimunov; Roger B Cohen; Alexander Lin; John N Lukens; Lee Hartner; Charu Aggarwal; Umamaheswar Duvvuri; Kathleen T Montone; Jalal B Jalaly; Virginia A LiVolsi; Ryan M Carey; Rabie M Shanti; Karthik Rajasekaran; Ara A Chalian; Christopher H Rassekh; Steven B Cannady; Jason G Newman; Bert W O'Malley; Gregory S Weinstein; Phyllis A Gimotty; Devraj Basu Journal: Oral Oncol Date: 2022-03-01 Impact factor: 5.972