Disease Profile and Oncologic Outcomes After Delayed Diagnosis of Human Papillomavirus–Associated Oropharyngeal Cancer. (December 2021)

• Record Type: Journal Article
• Authors: Yin, Linda X.; Karp, Emily E.; Elias, Anna; O'Byrne, Thomas J.; Routman, David M.; Price, Daniel L.; Kasperbauer, Jan L.; Neben-Wittich, Michelle; Chintakuntlawar, Ashish V.; Price, Katharine A.; Ma, Daniel J.; Foote, Robert L.; Moore, Eric J.; Van Abel, Kathryn M.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 165:Number 6(2021)
• Page Start: 830
• Page End: 837
• Publication Date: 2021-12
• Subjects: HPV -- human papillomavirus -- oropharynx -- oropharyngeal cancer -- delayed diagnosis -- diagnostic delay -- squamous cell -- outcomes -- prognosis; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/01945998211000426
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: Diagnostic delay in human papillomavirus–associated oropharynx squamous cell carcinoma (HPV(+)OPSCC) is common due to nonspecific symptoms. We aim to describe the disease burden and oncologic outcomes of patients with HPV(+)OPSCC diagnosed >12 months after symptom onset. Study Design: This is a retrospective cohort study of HPV(+)OPSCC patients receiving intent-to-cure treatment (including surgery ± adjuvant therapy or primary chemoradiation). Setting: 2006-2016, tertiary care center. Methods: Tumor stage was compared between patients with and without delayed diagnosis using χ 2 tests. Kaplan-Meier survival analysis with univariate and multivariable Cox regressions were used to determine the effect of diagnostic delay on oncologic outcomes. Results: In total, 664 patients were included. Compared to patients diagnosed <12 months from symptom onset (n = 601), those diagnosed at >12 months (n = 63) were more likely to have T4 disease and higher overall American Joint Committee on Cancer (AJCC) clinical stage at presentation ( P < .01 for both). At 5 years, rates of overall survival, cancer-specific survival, progression-free survival, and distant metastases–free survival in the delayed diagnosis cohort were 80%, 90%, 80%, and 89%, respectively. A >12-month delay in diagnosis did not significantly impact overall survival (adjusted hazard ratio [aHR], 1.16; 95% CI, 0.58-2.31), cancer-specific survival (aHR, 0.83; 95% CI, 0.29-2.39), progression-free survival (aHR, 1.15; 95% CI, 0.56-2.37), or distant metastases–free survival (aHR, 1.00; 95% CI, 0.42-2.40) after adjusting for age, sex, and clinical AJCC stage ( P > .05 for all). Conclusions: Delayed diagnosis of HPV(+)OPSCC is associated with greater burden of disease at presentation, but oncologic outcomes remain favorable across treatment modalities. When appropriate, intent-to-cure therapy should be pursued despite diagnostic delay. Level of Evidence: Level III.