High metastatic node number, not extracapsular spread or N-classification is a node-related prognosticator in transorally-resected, neck-dissected p16-positive oropharynx cancer. Issue 5 (May 2015)

• Record Type: Journal Article
• Authors: Sinha, Parul; Kallogjeri, Dorina; Gay, Hiram; Thorstad, Wade L.; Lewis, James S.; Chernock, Rebecca; Nussenbaum, Brian; Haughey, Bruce H.
• Is Part Of: Oral oncology. Volume 51:Issue 5(2015:May)
• Page Start: 514
• Page End: 520
• Publication Date: 2015-05
• Subjects: Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2015.02.098
• Languages: English
• ISSNs: 1368-8375

Abstract

<abstract xml:lang="en" abstract-type="author" id="ab010"> <title id="st095">Summary</title> <sec> <title id="st100">Background</title> <p id="sp0010">Due to unique biology and prognosis, precise identification of predictive parameters is critical for p16+ oropharyngeal squamous cell carcinoma (OPSCC). Prior studies showing absence of prognostication from extracapsular spread (ECS) and/or high N-classification in surgically-treated p16+ OPSCC necessitate new, evidence-based prognosticators.</p> </sec> <sec> <title id="st105">Methods</title> <p id="sp0015">A prospectively assembled cohort of 220, transoral surgery + neck dissection ± adjuvant therapy-treated, p16+ OPSCC patients was analyzed. Disease recurrence and disease-specific survival (DSS) were primary endpoints.</p> </sec> <sec> <title id="st110">Results</title> <p id="sp0020">Median follow-up was 59 (12–189) months. Distribution of metastatic node numbers was: 0 in 9.5% (<italic>n</italic> = 21), 1 in 33.6% (<italic>n</italic> = 74), 2 in 17% (<italic>n</italic> = 38), 3 in 14.5% (<italic>n</italic> = 32), 4 in 8.2% (<italic>n</italic> = 18), and <inline-formula><alternatives><inline-graphic xlink:href="ark:/27927/pgjcwgwk9k" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /><mml:math altimg="si1.gif" overflow="scroll" id="d13e1502" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mo>⩾</mml:mo></mml:mrow></mml:math></alternatives></inline-formula>5 in 17% (<italic>n</italic> = 37). ECS was recorded in 80% (<italic>n</italic> = 159), and N2c–N3 in 17% (<italic>n</italic> = 38). Adjuvant radiotherapy and chemoradiotherapy was administered in 44% and 34%. Recurrence developed in 22 patients (10%); 4 local, 5 regional, 2 regional and distant, and 11 distant. The 3- and 5-year DSS estimates were 94.6% and 93%. Multivariable logistic regression identified <inline-formula><alternatives><inline-graphic xlink:href="ark:/27927/pgjcwgwrbh" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /><mml:math altimg="si2.gif" overflow="scroll" id="d13e1526" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mo>⩾</mml:mo></mml:mrow></mml:math></alternatives></inline-formula>5 nodes and T3–T4 classification as predictors for recurrence. In multivariable Cox analyses, <inline-formula><alternatives><inline-graphic xlink:href="ark:/27927/pgjcwgwr5x" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /><mml:math altimg="si3.gif" overflow="scroll" id="d13e1532" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mo>⩾</mml:mo></mml:mrow></mml:math></alternatives></inline-formula>5 nodes, T3–T4 classification and margins were prognostic for DSS. ECS, N2c–N3 classification and smoking were not prognostic.</p> </sec> <sec> <title id="st115">Conclusions</title> <p id="sp0025">Metastatic node number, not ECS or high N-classification is an independent nodal predictor of outcomes in surgically-treated p16+ OPSCC patients. Despite high DSS (~80%), closer surveillance for recurrence is recommended for patients with <inline-formula><alternatives><inline-graphic xlink:href="ark:/27927/pgjcwgwrgk" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /><mml:math altimg="si4.gif" overflow="scroll" id="d13e1542" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mo>⩾</mml:mo></mml:mrow></mml:math></alternatives></inline-formula>5 metastatic nodes.</p> </sec> </abstract>