Volume 129, Issue 5 pp. 1141-1149
Head and Neck

Long-term analysis of transorally resected p16 + Oropharynx cancer: Outcomes and prognostic factors

Parul Sinha MBBS

Parul Sinha MBBS

Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A

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Bruce H. Haughey MBChB

Bruce H. Haughey MBChB

Department of Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, Florida, U.S.A

Department of Surgery, University of Auckland Faculty of Medicine and Health Sciences, Auckland, New Zealand

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Dorina Kallogjeri MD, MPH

Dorina Kallogjeri MD, MPH

Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A

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Ryan S. Jackson MD

Corresponding Author

Ryan S. Jackson MD

Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A

Send correspondence to Ryan S. Jackson, MD, Assistant Professor, Division of Head and Neck Cancer Surgery, Department of Otolaryngology–Head and Neck Surgery, Washington University in St. Louis School of Medicine, Campus Box 8115, St. Louis, MO 63110. E-mail: [email protected].Search for more papers by this author
First published: 27 August 2018
Citations: 31

Editor's Note: This Manuscript was accepted for publication on July 6, 2018.

This study was accepted for an oral presentation at the Annual Meeting of the Triological Society, National Harbor, Maryland, U.S.A., April 20, 2018.

The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objective

We observed high survival in a previous report of a p16-positive, oropharyngeal carcinoma (OPC) cohort treated primarily with transoral laser microsurgery (TLM) ± adjuvant therapy and followed for ≥ 12 months. To address long-term outcomes of primary transoral surgery for this unique disease, we present an updated analysis of our cohort with extended follow-up.

Methods

A prospectively assembled TLM cohort of 171 OPC patients was analyzed for disease-free, disease-specific, and overall survival (disease-free survival [DFS], disease-specific survival [DSS], overall survival [OS]) and functional outcomes, with a minimum follow-up of 60 months or to death.

Results

Median follow-up was 103 (60–201) months. Five-year DFS, DSS, and OS estimates were 85% (95% confidence interval [CI]: 80%–91%), 93% (95% CI: 89%–97%), and 90% (95% CI: 86%–95%). Recurrence occurred in 20 (12%; 7 locoregional, 13 distant); median time to recurrence was 18.8 months; and 90% occurred within 48 months. Age, smoking, American Joint Committee on Cancer 8th edition clinical tumor-category, pathologic tumor (pT)-category, pathologic tumor-node-metastasis (pTNM), and any adjuvant were significantly associated with disease-free survival in multivariable analyses, whereas pT-category, pN-category, TNM grouping, and angioinvasion were associated with DSS. A second primary developed in six (3.5%) patients. Indications for gastrostomy were recurrence/second primary (11), postadjuvant esophageal stenosis (6), comorbidities (3), and osteo/chondroradionecrosis (3); only seven (4%) had a gastrostomy tube in the absence of these factors, all of whom received adjuvant therapy. Two had a tracheostomy tube [chondoradionecrosis (1), recurrence (1)].

Conclusion

High 5-year survival and locoregional control were observed, with recurrence occurring more commonly as distant metastasis. The observed time to recurrence suggests posttreatment oncologic surveillance for at least 48 months. Identified prognosticators will inform adjuvant treatment considerations, trial planning, and patient counseling for long-term outcomes. Laryngoscope, 2018

Level of Evidence

2b Laryngoscope, 129:1141–1149, 2019

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