An evolution in demographics, treatment, and outcomes of oropharyngeal cancer at a major cancer center

Abstract

Background This retrospective review examines demographic/clinical characteristics and overall survival of patients with squamous cell carcinoma of the oropharynx (SCCOP) at a tertiary cancer center and reports the characteristics influencing any observed survival trends over time. Methods The study included 3891 newly diagnosed, previously untreated patients presenting to our institution between 1955 and 2004. Results Over time, patients presented at younger ages and were more likely to have base of tongue or tonsil tumors and to be never or former smokers. Patients diagnosed in 1995–2004 were almost half as likely to die as those diagnosed before 1995 (HR,0.6; 95% CI,0.6–0.8). In both multivariable and recursive partitioning survival analyses, the TNM staging system predicted survival of patients treated before 1995 but not of patients treated in 1995–2004. Conclusion Survival among patients with SCCOP improved substantially over the past 50 years. The main contributing factors were changes in clinical characteristics, in particular surrogates for HPV positivity. The current TNM staging system for SCCOP is inadequate. Incorporation of HPV status and perhaps smoking status is encouraged.

Does Quitting Smoking Make a Difference Among Newly Diagnosed Head and Neck Cancer Patients?

“…15,16,24 However, other studies fail to show a significant difference in mortality based on smoking status after controlling for covariates. [25][26][27][28] In the head and neck cancer literature, smoking significantly increases overall mortality and cancer-specific mortality, 10,21,23,[29][30][31][32][33][34] and pack-years of smoking has a dose-response positive relationship with mortality, 23,30,35 yet some studies reported nonsignificant differences in overall mortality [36][37][38][39] and cancer-specific mortality 37,40 between smokers and nonsmokers. However, previous studies are limited by a one-time smoking assessment at or after diagnosis (mostly at diagnosis), their retrospective nature, inability to control for covariates, and short follow-up periods.…”

New Strategies in Human Papillomavirus–Related Oropharynx Cancer: Effecting Advances in Treatment for a Growing Epidemic

“…Tobacco exposure does not increase risk for HPV þ OPC but does confer a negative impact on prognosis based on retrospective analyses of clinical trial data and a case series (10)(11)(12). In contrast to HPV À HNSCC, the AJCC/UICC TNM staging system is not prognostic and revision of the current staging system is needed (13,14).…”

Prognostic Value of Pretherapy Platelet Elevation in Oropharyngeal Cancer Patients Treated With Chemoradiation

“…Since previous data suggest that traditional TNM staging has comparatively limited predictive utility for oropharyngeal cancers 5 , patients were risk-stratified using a previouslypublished institutional oropharyngeal cancer risk partitioning schema by Dahlstrom et al 5 , which overlaps the current oropharynx chemoradiation cohort. Using the post-1994 Dahlstrom-Sturgis risk schema, we stratified patients into four risk groups ( Figure 1.A); confirmatory actuarial analysis was performed for verification.…”

“…These oropharyngeal cancers carry a comparatively better prognosis [5][6][7] , and represent a distinct pathobiological disease process, as compared to traditional tobaccoassociated cancers 8,9 . Furthermore, data suggest that traditional risk stratification variables, such as T-category or N-category, provide comparatively limited prognostic/predictive value for treatment response or survival 5,10 .…”