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- Title
Extracapsular extension, pathologic node status, and adjuvant treatment in primary surgery patients with human papillomavirus‐mediated oropharyngeal cancer: National hospital‐based retrospective cohort analysis.
- Authors
Day, Andrew T.; Yang, Alex M.; Tanamal, Priscilla; Blackwell, James‐Michael; Wang, Ellen; Sumer, Baran D.; Bishop, Justin A.; Hughes, Randall S.; Khan, Saad A.; Sher, David J.
- Abstract
Background: The significance of extracapsular extension (ECE) and adjuvant treatment paradigm in patients with surgically managed human papillomavirus‐positive (HPV+) oropharyngeal cancer (OPC) is debated. Methods: National, hospital‐based, retrospective cohort study of 2663 patients pN+ HPV+ OPC who underwent primary surgery. Results: Patients with ECE had a 1.74‐times risk of death (95% confidence interval [CI]: 1.26–2.40, p = 0.001) compared to patients without ECE. Among patients with pN1, ECE‐positive disease, risk of overall mortality was similar across treatment paradigms (surgery alone: ref; adjuvant radiation therapy [RT]: aHR: 0.81; 95% CI: 0.36–1.85; p = 0.62; adjuvant CRT: aHR: 0.66; 95% CI: 0.34–1.32; p = 0.24). Patients with pN2 ECE‐positive disease treated with adjuvant RT alone exhibited similar risk of all‐cause mortality (hazard ratio: 1.04, 95% CI: 0.24–4.47, p = 0.96) compared to adjuvant chemoradiation (CRT). In patients with advanced, ECE‐positive disease (e.g., pT3‐T4pN2), adjuvant CRT did not reduce the risk of overall mortality relative to adjuvant RT. Conclusion: Although pathologic ECE negatively predicts for survival in patients with HPV+ OPC, our analyses support expansion of postoperative de‐intensification clinical trial eligibility criteria in patients with ECE‐positive disease.
- Subjects
OROPHARYNGEAL cancer; COHORT analysis; ONCOLOGIC surgery; MORTALITY; RETROSPECTIVE studies; RADIOTHERAPY
- Publication
Head & Neck, 2021, Vol 43, Issue 11, p3345
- ISSN
1043-3074
- Publication type
Article
- DOI
10.1002/hed.26825