National treatment trends in human papillomavirus–positive oropharyngeal squamous cell carcinoma

Abstract

Background Human papillomavirus (HPV)–mediated oropharyngeal cancer (OPC) is associated with dramatically improved survival in comparison with HPV‐negative OPC and can be successfully treated with surgical and nonsurgical approaches. National treatment trends for OPC were investigated with the National Cancer Data Base (NCDB). Methods The NCDB was reviewed for primary HPV‐mediated OPC in 2010‐2014. Multivariable regression was used to identify predictors of both nonsurgical therapy and receipt of adjuvant chemoradiation (CRT). Results There were 13,363 patients identified with a median age at diagnosis of 58 years. The incidence of triple‐modality treatment (surgery with adjuvant chemotherapy) decreased from 23.7% in 2010 to 16.9% in 2014 (R2 = 0.96), whereas the incidence of nonsurgical treatment increased from 63.9% to 68.7% (R2 = 0.89). Hospitals in the top treatment volume quartile (quartile 1 [Q1]; n = 29) had a lower rate of positive margins (16.3%) than bottom‐quartile centers (n = 741; rate of positive margins, 36.4%; P < .001); Q1 hospitals used surgical therapy significantly more. Independent predictors of nonsurgical therapy included older age, advanced disease, lower hospital volume, and living closer to the hospital or outside the Pacific United States. In surgically treated patients, younger age, lower hospital volume, nodal disease, positive surgical margins, and extranodal extension (ENE) also predicted more adjuvant CRT use. Conclusions The use of upfront surgical treatment decreased from 2010 to 2014. Hospital volume shows a strong, inverse correlation with the rate of positive surgical margins. The upfront treatment strategy is predicted not only by staging but also by patient‐, geographic‐, and hospital‐specific factors. Lower hospital volume remains independently associated with increased triple‐modality therapy after adjustments for positive margins, ENE, and pathologic staging.

Time to Surgery and Survival in Head and Neck Cancer

“…12 The oropharynx primary site codes included C01.9, C02.4, C05.1, C05.2, C09.0, C09.1, C09.8, C09.9, C10.2, C10.3, and C10.9. 13 The hypopharynx primary site codes included C12.9, C13.0, C13.1, C13.2, C13.8, and C13.9. The larynx primary site codes included C10.1, C32.1, C32.0, C32.2, C32.8 and C32.9.…”

“…We sought to further filter the aforementioned cohort to ensure that patients included in this study underwent definitive primary surgery. 13,14 Patients who had undergone preoperative chemotherapy, radiation therapy, or both were excluded. To ensure that patients received definitive surgery, the primary-site surgical codes from the Surveillance, Epidemiology, and End Results (SEER) Program Code Manual (3rd edition, revision 1) then were selected for each subsite that were unlikely to denote diagnostic biopsies.…”

“…Due to concerns that a proportion of patients classified as 30 or 31 did not receive definitive surgery, patients were included only if they also had more than 10 lymph nodes examined during surgery. 13 The larynx codes were 30, 31, 32, 33, 40, 41, 42, 50 and 80. The hypopharynx codes were 32, 40, 41, 42, 43, 50, 51, and 52.…”

Role of Human Papillomavirus Infection in Head and Neck Cancer in Italy: The HPV-AHEAD Study

“…Italian data on HPV status in HNSCC were reported from three other studies with HPV-DNA/HPV-E6*I mRNA double positivity with variable ranges such as 37.9% in OPC (1992-2015) [6], 6% in OC, 20% in OPC, and 1% in LC (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) [10], and 32.3% in more recent years (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) for OPC [11]. Indeed, in Italy, HPV infection plays a role in HNSCC similarly to the rest of the Western world, not only for its well documented positive prognostic value but also for its mediation in carcinogenesis [12,13]. However, currently, it is crucial to fully understand how the presence of HPV interacts with other risk factors such as smoking and alcohol in HNSCC in this region [14,15].…”

Increased rate of recurrence and high rate of salvage in patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma with adverse features treated with primary surgery without recommended adjuvant therapy

“…15,16 Despite efforts to deintensify therapy, most patients with HPV-associated OPSCC continue to receive adjuvant radiation, albeit at reduced doses under investigational de-intensification regimens, 9,17 and a minority still require tri-modality therapy with chemoradiation. 18 At our center, we identified a cohort of patients with HPV-associated OPSCC treated with TORS and neck dissection who did not receive the adjuvant radiation indicated by current guidelines for high-risk features. Here we define the oncologic outcomes of these patients in comparison to those completing indicated adjuvant therapy, determine features-associated recurrence in the surgery alone group, and quantify salvage potential of recurrences in this setting.…”