Relapse Rates With Surgery Alone in Human Papillomavirus–Related Intermediate- and High-Risk Group Oropharynx Squamous Cell Cancer: A Multi-Institutional Review

Routman, David M.; Funk, Ryan K.; Tangsriwong, K.; Lin, Alexander; Keeney, Michael; García, Joaquín J.; Zarka, Matthew A.; Lewis, Jason T.; Stoddard, David G.; Moore, Eric J.; Day, Courtney N.; Zhai, Qihui; Price, Katharine A.; Lukens, John N.; Swisher‐McClure, Samuel; Weinstein, Gregory S.; O’Malley, Bert W.; Foote, Robert L.; Daniel, J.

doi:10.1016/j.ijrobp.2017.06.2453

Cited by 32 publications

(26 citation statements)

References 35 publications

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“…Previous studies assessing the risk of recurrence in HPV+ OPSCC patients treated with surgery alone have shown favorable outcomes for many intermediate-risk patients [22–24]. A recent retrospective multi-institutional study of 53 patients with HPV+ OPSCC supports our findings that there is a substantial group that are potential candidates for deintensification to surgery alone [23]. This study reported a 3-year recurrence free survival rate of 88% in intermediate-risk patients undergoing surgery alone [23].…”

Section: Discussionsupporting

confidence: 84%

“…A recent retrospective multi-institutional study of 53 patients with HPV+ OPSCC supports our findings that there is a substantial group that are potential candidates for deintensification to surgery alone [23]. This study reported a 3-year recurrence free survival rate of 88% in intermediate-risk patients undergoing surgery alone [23]. The long-term morbidity from transoral surgery alone is minimal [25] and significantly better than when adjuvant RT or CRT is required [26], making this an attractive option to pursue for future deintensification efforts.…”

Section: Discussionsupporting

confidence: 79%

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Primary surgery for human papillomavirus-associated oropharyngeal cancer: Survival outcomes with or without adjuvant treatment

et al. 2018

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Objectives Human papillomavirus-associated (HPV + ) oropharyngeal squamous cell carcinoma (OPSCC) is a unique form of head and neck cancer with improved prognosis. We assessed survival for stage I patients with low- or intermediate-risk pathologic features with surgery alone compared with surgery with adjuvant radiation (RT) or chemoradiation (CRT). Materials and methods We identified patients with stage I HPV+ OPSCC (after restaging with 8th edition staging system) treated with surgery alone, adjuvant RT or CRT in the National Cancer Data Base from 2010 to 2013. We compared survival for low-risk patients (≤1 metastatic lymph nodes with no adverse features) and intermediate-risk patients (2–4 metastatic lymph nodes, microscopic extranodal extension (ENE) or lymphovascular invasion). Results We examined 1677 patients with median follow-up of 43.9 months. In the intermediate-risk group, 4-year overall survival was 94.0% with surgery alone, 91.5% with adjuvant RT and 92.0% with adjuvant CRT (p = 0.72). There were similar rates of overall survival in the low-risk group. In multivariable models accounting for clinicopathologic differences the dose of adjuvant RT was not associated with mortality. On Cox proportional hazard modeling, adjuvant RT (HR 0.94; CI 0.43–2.08) or CRT (HR 0.96; CI 0.45–2.11) did not significantly improved survival compared with surgery alone in the intermediate-risk group (reference). Similar results were seen in the low-risk group. The composite number of pathologic risk features significantly improved risk stratification. Conclusion We provide observational evidence that adjuvant RT or CRT does not provide a survival benefit for stage I HPV+ OPSCC with low- or intermediate-risk pathologic features.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 79%

Primary surgery for human papillomavirus-associated oropharyngeal cancer: Survival outcomes with or without adjuvant treatment

et al. 2018

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“…Some patients in this NCDB cohort may have recurred and been successfully salvaged with radiation or even revision surgery and thus survived to the follow‐up point. Recent studies do show that recurrence rates may be higher after surgery alone patients with some adverse features but that the survival rates are not impacted possibly because salvage treatments were successful . Another limitation of studying an often indolent form of cancer such as HPV + OPSCC is that death from disease may take several years, thereby making 3‐year and even 5‐year survival analyses less relevant.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Mortality in HPV‐Associated Oropharynx Carcinoma Treated With Surgery Alone

et al. 2019

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Objective Survival outcomes for human papillomavirus‐associated oropharynx squamous cell carcinoma (HPV + OPSCC) treated with surgery alone are unclear. To increase understanding, we assessed overall survival (OS) outcomes using the national cancer database (NCDB). Methods We conducted a retrospective analysis of OS of 736 NCDB HPV + OPSCC patients who underwent surgery alone from 2010 to 2014 using univariate and multivariate analyses and the Kaplan‐Meir method. Results Multivariable analysis found the following independent risk factors for death: American Joint Commission on Cancer (AJCC) 8th edition pathologic stage(p)N2 versus pN0 disease (hazard ratio [HR], 5.5; P = 0.000006), macroscopic extranodal extension (ENE) versus non‐ENE (HR, 4.9; P < 0.02), a positive lymph nodes (LN) percentage of ≥10% (HR, 4.2; P = 0.0002), and five or more positive LNs (HR, 4.9; P = 0.00004). Three‐year OS was significantly worse for AJCC 8th edition pN2 versus pN0 but not for 7th edition pN2 versus pN0 disease. Five‐year OS was significantly worse for positive versus negative surgical margins, AJCC 8th edition stage II versus I, and either microscopic or macroscopic ENE versus non‐ENE positive LNs. For 523 (71%) AJCC 8th edition stage I patients and for 283 (38%) patients who were pT1–T2, with negative margins, pN0–N1, with ≤4 pathologic LNs, without ENE, and with >20 LNs removed during neck dissection, the 3‐year OS rates were 93% and 95%, respectively, and the 5‐year OS rates were 91% and 95%, respectively. Conclusion In the context of the lack of detail and possible inaccuracies found in the NCDB, surgery alone for AJCC 8th edition stage I HPV + OPSCC, particularly pT1–T2, pN0–N1 with ≤4 pathologic LNs, without ENE, and with negative surgical margins has a high OS. Level of Evidence 4 Laryngoscope, 130:E423–E435, 2020

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“…Among all 53 patients, the 3-year cumulative incidence of relapse was 26.0%. The 3-year cumulative incidence was 11.8% in the 37 intermediate-risk patients (perineural invasion, lymphovascular invasion, T3-T4, or N2 disease) and 52.4% in the 16 high-risk patients (ENE or positive margins) (15). This argues that the traditional high-risk features are still valid for recurrence even in P16+ oropharyngeal cancer patients.…”

Section: Discussionmentioning

confidence: 95%

Clinical Outcomes of Head and Neck Cancer Patients Who Undergo Resection, But Forgo Adjuvant Therapy

et al. 2019

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Background/Aim: This study aimed to evaluate the outcomes of patients with head and neck squamous cell carcinoma (HNSCC) who underwent resection and refused the recommended adjuvant therapy. Patients and Methods: Locoregional recurrence-free survival (LRRFS) and time to progression (TTP) were assessed in HNSCC patients treated with surgery who declined some or all adjuvant therapy (refusal group (RG)) compared to those who received the recommended adjuvant therapy (TG). Results: With a median follow-up of 23 months, the 2-year LRRFS was significantly lower in the 17 patients from the RG compared to the 152 patients from the TG: 23.1% vs. 69%, HR=0.30, 95% confidence incidence (CI)=0.15-0.59; p<0.001. The mean TTP was 12 months in the RG and was not reached in the TG (p<0.001). Conclusion: Patients with HNSCC who declined the recommended adjuvant therapy had a recurrence rate of 50% within a year. Adjuvant radiation therapy is the standard of care for resected head and neck squamous cell carcinoma (HNSCC) with adverse risk factors, such as the presence of multiple involved nodes, inadequate surgical margins, pT3-4 disease, 4885 This article is freely accessible online.

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Relapse Rates With Surgery Alone in Human Papillomavirus–Related Intermediate- and High-Risk Group Oropharynx Squamous Cell Cancer: A Multi-Institutional Review

Cited by 32 publications

References 35 publications

Primary surgery for human papillomavirus-associated oropharyngeal cancer: Survival outcomes with or without adjuvant treatment

Primary surgery for human papillomavirus-associated oropharyngeal cancer: Survival outcomes with or without adjuvant treatment

Predictors of Mortality in HPV‐Associated Oropharynx Carcinoma Treated With Surgery Alone

Clinical Outcomes of Head and Neck Cancer Patients Who Undergo Resection, But Forgo Adjuvant Therapy

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