Extracapsular spread in head and neck carcinoma: Impact of site and human papillomavirus status

Abstract

BACKGROUND: Extracapsular spread (ECS) in cervical lymph node metastases from head and neck squamous cell carcinoma (SCC) is regarded as an adverse prognostic factor and is often used to select patients who may benefit from adjuvant therapy. The prognostic value of ECS was evaluated for patients with oropharyngeal SCC (OPC; with known p16/human papillomavirus [HPV] status) and for patients with SCC of the oral cavity (OCC). METHODS: Disease-specific survival (DSS) was assessed among SCC patients with cervical lymph node metastases (n 5 347, including 133 patients with OPC and 214 patients with OCC). All patients were treated surgically between 1983 and 2009. ECS status was determined by pathologists at the time of initial pathologic evaluation and confirmed for this study. HPV status of patients with OPC was determined via immunohistochemistry for p16 and in situ hybridization. RESULTS: Among OCC patients, ECS was a significant, independent factor influencing DSS. For OCC patients with ECS, 3-year DSS was 45% (95% confidence interval [CI], 36%-56%); for those without ECS, 3-year DSS was 71% (95% CI, 62%-81%; P 5.0018). The effect of ECS was independent of the number of positive lymph nodes as well as other clinical, pathologic, and treatment variables. Of the 133 OPC patients, 76 (57%) were p16-positive and 57 (43%) were p16-negative. ECS status did not correlate with DSS among p16-positive or p16-negative OPC patients. CONCLUSION: ECS was not associated with worse DSS in p16-positive or p16-negative OPC patients.

Human Papillomavirus-Associated Adenocarcinoma of the Base of Tongue: Potentially Actionable Genetic Changes

“…HPV-associated oropharyngeal SCC treated from 1983 to 2013 at the University of Pittsburgh Medical Center and identified as part of a prior project (n = 89) [20] were re-reviewed with the knowledge of HPV-associated adenocarcinoma, NOS, of the BOT [9,10].…”

“…HPV-Associated Adenocarcinomas, NOS, of the BOT, are Unlikely to be Misdiagnosed as Oropharyngeal Squamous Cell Carcinomas HPV-associated oropharyngeal SCC treated from 1983 to 2013 in the University of Pittsburgh Medical Center and identified as part of a prior project (n = 89) [20] were rereviewed and the diagnosis of squamous cell carcinoma was confirmed in all cases.…”

De-intensification of adjuvant therapy in human papillomavirus-associated oropharyngeal cancer

“…In the Washington University experience of p16+ OPC patients after eHNS, the rate of DFS was not significantly different amongst patients whose pathology reports described ENE versus those without, with 3-year disease-specific survival (DFS) estimates of 89% (95% CI 84-95%) and 94% (95% CI 83-100%), [28]. In a subsequent update, these patients were reported to have a 5-year DSS of 84.8% (95% CI 64.4-94.05%) in patients with ENE and 89.3% (95% CI 73.9-98.1%) in patient without ENE [29].…”

Solid Lymph Nodes as an Imaging Biomarker for Risk Stratification in Human Papillomavirus–Related Oropharyngeal Squamous Cell Carcinoma

“…Four hundred forty-one patients with HPV-positive OPSCC were identified from our head and neck cancer registry from 1984 to 2014. 13,14 HPV positivity was determined by in situ hybridization by using probes targeting 37 HPV subtypes, including the following: 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, and 52 (Y1404; Dako, Carpinteria, California). Five-micrometer tissue sections were deparaffinized and digested with proteinase K (Roche Diagnostics, Indianapolis, Indiana).…”