Imaging at diagnosis impacts cancer‐specific survival among patients with cancer of the oropharynx

Abstract

Background The optimal imaging for the staging of oropharyngeal cancer is not well defined. Methods The linked Surveillance, Epidemiology, and End Results (SEER)–Medicare database for 2006 through 2011 was used to compare patient characteristics and hospital region by the initial imaging modality used for patients with oropharyngeal cancer. The primary outcome was 3‐year cancer‐specific survival (CSS). Cox proportional hazards models were adjusted for imaging, age, sex, region, education, race, American Joint Committee on Cancer stage of disease, and treatment, which were examined using backward elimination. The authors also explored how initial imaging use varied by patient characteristics and hospital region. Results A total of 1765 patients underwent initial diagnostic imaging. Of those, approximately 11.4% (202 patients) received computed tomography (CT) alone as their initial imaging modality, 5.2% (91 patients) underwent magnetic resonance imaging (MRI) without positron emission tomography (PET), and 83.3% (1472 patients) had initial imaging that included PET. The overall 3‐year CSS rate for the entire population was 63.7%. In the adjusted survival models compared by initial imaging modality, patients who underwent a PET examination were found to have higher survival than those who underwent CT alone or MRI, respectively (hazard ratio, 1.337 [95% CI, 1.001‐1.785; P = .0491]; and hazard ratio, 1.748 [95% CI, 1.2‐2.545; P = .0036]). Conclusions Among patients with oropharyngeal cancer, initial staging with PET imaging was associated with improved 3‐year CSS compared with initial staging with MRI or CT.

Incidence and survival in oral and pharyngeal cancers in Finland and Sweden through half century

“…These are likely to include earlier detection because of improved imaging and more efficient treatment, including radiotherapy [ 2 , 24 , 25 ]. Particularly, utilization of positron emission tomography (PET), has led to earlier diagnosis and more precise staging in these cancers [ 39 , 40 ]. Standardized treatment protocols, multidisciplinary tumor boards together with advances in surgical and oncological treatments have also contributed to increased survival [ 41 , 42 ].…”

Head and neck squamous cell cancer associated with lymphoproliferative malignancies is aggressive

“…The patient in case four was most recently diagnosed in 2015, at a time when PET scanning was more readily available, and this is likely to have affected survival. 24 Furthermore, two patients in our case series had HPV-positive oropharyngeal SCC. This is a distinct SCC subtype, which has increased in incidence over the last three decades, and is associated with a better prognosis than HPV-negative disease.…”

The Prognostic Impact of Radiotherapy Delays in Oropharynx Carcinoma and the Role of p16 Status

“…PET staging was not associated with LRR or CSS in our study, however, the use of PET has been shown to have greater sensitivity for oropharynx SCC disease detection compared with CT. 15 The use of PET staging has also been associated with improved 3-year oropharyngeal CSS in a recent SEER analysis. 13 In our cohort, a relatively small number of patients did not have PET staging, thus reducing our power to detect a significant survival benefit. p16 status should not be a significant factor in the triage process determining when to assess patients as it was not shown to be prognostic in this study.…”

“…A retrospective analysis by Goel et al12 in a population of surgically managed oropharynx cancer revealed that time from diagnosis to surgery was predictive of inferior clinical outcomes only in non–HPV-related oropharynx carcinoma, but not in HPV-related disease. Tumati et al13 also showed that TDs were associated with an increase in distant metastases in surgically managed oropharynx cancer patients, but this was limited in p16 − patients. It is possible that a more significant detriment with TD in p16 − patients was shown in these surgical studies as HPV nonrelated disease has been shown to have increased risk of tumor relapse and inferior OS in surgically managed patients 14…”