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: Oropharynx cancer -- Adjuvant chemotherapy -- Adjuvant Radiotherapy -- p16 gene -- Human papillomavirus -- Head and neck cancer -- Extracapsular Spread -- p16-positive; 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

Summary: Background: 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. Methods: 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. Results: Median follow-up was 59 (12–189) months. Distribution of metastatic node numbers was: 0 in 9.5% ( n = 21), 1 in 33.6% ( n = 74), 2 in 17% ( n = 38), 3 in 14.5% ( n = 32), 4 in 8.2% ( n = 18), and ⩾ 5 in 17% ( n = 37). ECS was recorded in 80% ( n = 159), and N2c–N3 in 17% ( n = 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 ⩾ 5 nodes and T3–T4 classification as predictors for recurrence. In multivariable Cox analyses, ⩾ 5 nodes, T3–T4 classification and margins were prognostic for DSS. ECS, N2c–N3 classification and smoking were not prognostic. Conclusions: 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 ⩾ 5 metastatic nodes.