The prognostic role of medical comorbidities in surgically treated human papillomavirus-associated oropharyngeal squamous cell carcinoma. (September 2020)

• Record Type: Journal Article
• Authors: Yin, Linda X.; Puccinelli, Cassandra L.; Price, Daniel L.; Karp, Emily E.; Price, Katharine A.; Ma, Dan J.; Lohse, Christine; Moore, Eric J.; Abel, Kathryn M. Van
• Is Part Of: Oral oncology. Volume 108(2020)
• Publication Date: 2020-09
• Subjects: Oropharyngeal squamous cell carcinoma -- TORS -- Survival -- Human papillomavirus -- HPV -- Medical comorbidities -- Diabetes; 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.2020.104822
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Medical comorbidities affect oncologic outcomes in HPV(+) oropharyngeal cancer. Diabetes is associated with worse distant metastases-free survival. The prognostic effect of diabetes is independent of tumor stage. Diabetes may also worsen cancer-specific survival. Abstract: Objective: Prognostic factors specific to surgically managed human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) are not fully understood. Medical co-morbidities may have an impact on survival after surgical treatment. We aimed to identify co-morbidities associated with distant metastases-free survival (DMFS) and cancer-specific survival (CSS) in HPV(+)OPSCCs. Methods: This is a retrospective case series of HPV(+)OPSCC patients at a tertiary referral center from 2007 to 2016. All patients in the study underwent primary intent-to-cure transoral resection with concomitant neck dissection ± adjuvant radiation ± chemotherapy. Exclusion criteria included a history of previous head and neck cancer or distant metastases at diagnosis. Associations with DMFS and CSS were evaluated using univariable and multivariable Cox regression and summarized with hazard ratios (HRs). Results: 406 patients were included in the cohort (100% HPV(+), 90% Male). All had tumors of the tonsil (62%) or base of tongue (38%). Median follow-up for the cohort was 4.0 years (IQR: 2.6–6.2). Higher tumor stage and a higher Adult Comorbidity Evaluation-27 score were significantly associated with worse DMFS and CSS (p < 0.02 for all). A history of diabetes mellitus (N = 36, 9%) was significantly associated with DMFS (HR 3.05 [95%CI 1.26–7.37], p = 0.014) and CSS (HR 4.82 [95%CI 1.84–12.61], p = 0.001). On multivariable analysis, after adjusting for tumor stage, diabetes remained significantly associated with worse DMFS (HR 2.58 [95%CI 1.06–6.26], p = 0.037). Conclusion: Diabetes mellitus may be associated with worse DMFS and CSS in surgically managed HPV(+)OPSCC.