Purpose/Objective(s): Current treatment guidelines for T1-T3 oropharynx squamous cell carcinoma (OPC) offer surgical (Surg) or nonsurgical (NSurg) treatments as equivalent alternatives. In order to make value decisions, we must understand cost of care. Our goal was to identify the primary determinants of cost and we hypothesized that surgical treatment did not increase cost of care in OPC. To this end, we examined the relationship of cost to tumor stage, AJCC cancer stage, Charlson agecomorbidity index (CACI), and treatment strategy (Surg vs NSurg). Materials/Methods: Retrospective review of patient records in EPIC identified 299 patients with a diagnosis of oropharynx cancer between July 12, 2011, and May 15, 2015. We excluded patients with tumors that extended to the oral cavity, those with second primaries or distant metastases, and those whose histology was other than squamous cell carcinoma (SCC). We identified 71 patients staged T1-T3 who received all their treatment (S, RT, and/or CRT) at our facility. Cost was defined as revenue collected by the hospital and clinic for a 6-month episode of care that started with a biopsy positive for OPC. Results: A total of 72 patients were available for evaluation. Forty-two were treated with Surg and 29 were treated with NSurg. Among the Surg patients, 22 received adjuvant treatment. Of those tested for p16, 92.5% (62/67) were positive and 4 had unknown p16 status. All 5 p16 negative patients were treated with Surg. Among the 4 patients with unknown p16 status, 1 was treated with Surg and 3 with NSurg. Median age was 61 and 62 for the Surg and NSurg groups (tZ-0.16, PZ.8747). There were no differences between the Surg and NSurg groups in distribution of T stage (c 2 Z4.83, PZ.0893) or AJCC Stage (c 2 Z6.06, PZ.1946). Comorbidity was higher for the Surg group (CACIZ8.07) relative to the NSurg group (CACIZ7.34) but this did not reach significance (tZ-1.36, PZ.1792). Cost was lowest for those treated with surgery only relative to the NSurg group ($38,462 vs $83,222; tZ2.26, PZ.0298). Surgery followed by adjuvant CRT had similar cost to primary CRT (respectively, $84,598 and $83,222; tZÀ0.06, PZ.9528) Conclusion: Surgically treated patients with higher CACI, similar age, and greater proportion of p16-negative tumors had more favorable cost relative to those treated with primary CRT. Surgical patients who require adjuvant CRT had similar cost to those treated with primary CRT. The highest opportunity for cost savings is in those patients who do not require adjuvant CRT. Starting with a surgical approach does not increase cost even for those who require adjuvant treatment. Future research should determine which treatment strategy yields the best value.

significance (One-way ANOVA), average Area-Under-Receiver-Operating-Characteristic (AUC), and Positive and Negative Predictive values (PPV and NPV) were computed to estimate the generalization-error and prediction performance of the classifiers. Results: Five clinical factors, including T-stage, smoking status, and age; and 21 radiomic features, including tumor morphology, textural information, and intensity contrast were found to be statistically significant discriminators between HPV positive and negative cohorts. Performances for prediction of HPV status for the 3 classifiers were: Radiomics Elastic-Net-GLM: AUC/PPV/NPV = 0.799/0.775/0.802; Clinical Elastic-Net-GLM: 0.673/0.738/0.679, and Integrated/Ensemble Elastic-Net-GLM: 0.912/ 0.884/0.860. Results imply that the radiomics-based classifier significantly outperforms that using clinical factors only, and that the combination of both radiomics and clinical factors yields even higher predictive performance. Conclusion: Albeit subject to confirmation in a larger cohort, this pilot study presents encouraging results in support of the role of radiomic features towards characterization of HPV in patients with OPSCC.

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70.3%(P>0.05). In Per1 and Per3 protein positive groups, PFS in 1 year, 2 years and 3 years were 96.6%, 69% and 55.2%, respectively; in negative groups, PFS in 1 year, 2 years and 3 years were 71%, 32.3% and 16.1%(P<0.05).PFS in Per2 positive group in 1 year, 2 years and 3 years were 96.3%, 77.8% and 59.2%, respectively; negative group in 1 year, 2 years and 3 years were 72.7%, 33.3% and 24.2% (P<0.05); RFS in Per1 and Per3 negative groups in 1 year, 2 years and 3 years were 77.4%, 45.2% and 35.5%, respectively; positive group in 1 year, 2 years and 3 years were 96.6%, 82.8% and 67.7% (P<0.05). RFS in Per2 protein negative group in 1 year, 2 years and 3 years were 81.8%, 48.4.% and 36.3%, respectively; positive group in 1 year, 2 years and 3 years were 96.3%, 81.5% and 66.7% (P<0.05). Conclusion: Per1, Per2 and Per3 genes may play a critical role in the occurrence and development of HNSCC,compared with negative Per1 and Per3 protein expression, patients with positive Per1 and Per3 protein expression may have longer OS and show the trend of extended PFS and RFS.

2016-11-02T18:49:00