Staging and treatment of oropharyngeal cancer in the human papillomavirus era. Issue 7 (12th July 2014)

• Record Type: Journal Article
• Authors: Ward, Matthew J.; Mellows, Toby; Harris, Scott; Webb, Andrew; Patel, Nimesh N.; Cox, Hugh J.; Piper, Kim; Ottensmeier, Christian H.; Thomas, Gareth J.; King, Emma V.
• Is Part Of: Head & neck. Volume 37:Issue 7(2015:Jul.)
• Page Start: 1002
• Page End: 1013
• Publication Date: 2014-07-12
• Subjects: Head -- Diseases -- Periodicals; Neck -- Diseases -- Periodicals; Head -- Periodicals; Neck -- Periodicals; Face -- Periodicals; 617.51059
• DOI: 10.1002/hed.23697
• Languages: English
• ISSNs: 1043-3074

Abstract

<abstract abstract-type="main"> <title>ABSTRACT</title> <sec id="hed23697-sec-0001" sec-type="section"> <title>Background</title> <p>Oropharyngeal squamous cell carcinoma (SCC) is staged using the TNM system. Human papillomavirus (HPV)‐positive tumors have improved prognosis, despite presenting at advanced stage. Optimal treatment and stratification of HPV‐positive patients are not clearly defined.</p> </sec> <sec id="hed23697-sec-0002" sec-type="section"> <title>Methods</title> <p>We retrospectively analyzed 266 patients with oropharyngeal SCC for mortality and feeding tube dependency related to TNM stage, HPV status, and treatment.</p> </sec> <sec id="hed23697-sec-0003" sec-type="section"> <title>Results</title> <p>TNM staging was prognostic in HPV‐negative patients (stage III/IV hazard ratio [HR], 2.00; <italic>p</italic> = .05; N<sup>+</sup> HR, 2.19; <italic>p</italic> = .02). Only T classification was prognostic in HPV‐positive tumors (T3/T4 HR 3.31; <italic>p</italic> = .006). HPV‐positive tumors showed improved survival regardless of treatment. Patients receiving chemotherapy had a significantly increased risk of feeding tube dependency (odds ratio [OR], 1.72; <italic>p</italic> = .03).</p> </sec> <sec id="hed23697-sec-0004" sec-type="section"> <title>Conclusion</title> <p>These data suggest that the current TNM system has little prognostic value in HPV‐positive oropharyngeal SCC. Patients with HPV‐positive tumors show improved survival independent of treatment. The addition of chemotherapy increases the risk of feeding tube dependency and could potentially be avoided in T1/T2 HPV‐positive tumors without compromising survival. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1002–1013, 2015</p> </sec> </abstract>