Oncologic outcomes of human papillomavirus-associated oropharynx carcinoma treated with surgery alone: A 12-institution study of 344 patients

William R Ryan; Mary J Xu; Edgar Ochoa; Karolina A Plonowska-Hirschfeld; Aaron L Zebolsky; Patrick K Ha; Arnaud F Bewley; Jonathan Mallen-St Clair; Arjun S Joshi; Charles S Coffey; Farhoud Faraji; Bridget V MacDonald; Jeffrey J Houlton; Theodore A Gobillot; Joseph M Curry; Ramez Philips; Trevor G Hackman; Jeremy D Richmon; Andrew J Holcomb; Andrew M Coughlin; Aru Panwar; Russell B Smith; Matthew E Herberg; Carole Fakhry; David M Cognetti

doi:10.1002/cncr.33611

Oncologic outcomes of human papillomavirus-associated oropharynx carcinoma treated with surgery alone: A 12-institution study of 344 patients

Cancer. 2021 Sep 1;127(17):3092-3106. doi: 10.1002/cncr.33611. Epub 2021 May 6.

Authors

William R Ryan¹, Mary J Xu², Edgar Ochoa³, Karolina A Plonowska-Hirschfeld², Aaron L Zebolsky⁴, Patrick K Ha¹, Arnaud F Bewley⁵, Jonathan Mallen-St Clair⁶, Arjun S Joshi⁷, Charles S Coffey⁸, Farhoud Faraji⁸, Bridget V MacDonald⁹, Jeffrey J Houlton¹⁰, Theodore A Gobillot¹¹, Joseph M Curry¹², Ramez Philips¹², Trevor G Hackman¹³, Jeremy D Richmon¹⁴, Andrew J Holcomb^{14

15}, Andrew M Coughlin¹⁵, Aru Panwar¹⁵, Russell B Smith¹⁶, Matthew E Herberg¹⁷, Carole Fakhry¹⁷, David M Cognetti¹²

Affiliations

¹ Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California.
² Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California.
³ School of Medicine, University of California San Francisco, San Francisco, California.
⁴ Homer Stryker MD School of Medicine, Western Michigan University, Kalamazoo, Michigan.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, California.
⁶ Ear, Nose, and Throat, Cedars-Sinai Medical Center, Los Angeles, California.
⁷ Division of Head and Neck Oncologic Surgery, Department of Surgery, George Washington University School of Medicine, Washington, DC.
⁸ Division of Otolaryngology/Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California.
⁹ School of Medicine, University of California San Diego, La Jolla, California.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington.
¹¹ School of Medicine, University of Washington Medical Center, Seattle, Washington.
¹² Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
¹³ Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts.
¹⁵ Head and Neck Surgical Oncology, Nebraska Methodist Health System, Omaha, Nebraska.
¹⁶ Section of Head and Neck Surgical Oncology, Baptist MD Anderson Cancer Physicians, Baptist Medical Center, Jacksonville, Florida.
¹⁷ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.

PMID: 33957701
DOI: 10.1002/cncr.33611

Abstract

Background: The oncologic outcomes of surgery alone for patients with American Joint Committee on Cancer 7th edition (AJCC 7th) pN2a and pN2b human papillomavirus-associated oropharynx squamous cell carcinoma (HPV+OPSCC) are not clear.

Methods: The authors performed a 12-institution retrospective study of 344 consecutive patients with HPV+OPSCC (AJCC 7th pT0-3 N3 M0) treated with surgery alone with 6 months or more of follow-up using univariate and multivariate analyses.

Results: The 2-year outcomes for the entire cohort were 91% (182 of 200) disease-free survival (DFS), 100% (200 of 200) disease-specific survival (DSS), and 98% (200 of 204) overall survival (OS). The 18 recurrences within 2 years were 88.9% (16 of 18) local and/or regional recurrences and 11.1% (2 of 18) distant metastases. Recurrences were not significantly associated with smoking, pT stage, or pN stage. The 16 patients with locoregional recurrences within 2 years all underwent successful salvage treatments (median follow-up after salvage: 13.1 months), 43.8% (7 of 16) of whom underwent salvage surgery alone for a 2-year overall salvage radiation need of 4.5% (9 of 200). The 2-year outcomes for the 59 evaluable patients among the 109 AJCC 7th pT0-2 N2a-N2b patients with 1 to 3 pathologic lymph nodes (LNs) were as follows: local recurrence, 3.4% (2 of 59); regional recurrence, 8.4% (5 of 59); distant metastases, 0%; DFS, 88.1% (52 of 59); DSS, 100% (59 of 59); OS, 96.7% (59 of 61); and salvage radiation, 5.1% (3 of 59).

Conclusions: With careful selection, surgery alone for AJCC 7th pT0-T2N0-N2b HPV+OPSCC with zero to 3 pathologic LNs without perineural invasion, extranodal extension, or positive margins results in high DFS, DSS, OS, and salvage treatment success. Because of the short-term follow-up, these data support further investigation of treatment de-escalation in this population.

Keywords: disease-free survival; disease-specific survival; human papillomavirus; oropharyngeal cancer; oropharynx carcinoma; outcomes; pN2a; pN2b; recurrence; surgery alone.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Alphapapillomavirus*
Carcinoma, Squamous Cell* / pathology
Head and Neck Neoplasms* / pathology
Humans
Neoplasm Staging
Oropharyngeal Neoplasms* / pathology
Oropharynx / pathology
Papillomaviridae
Papillomavirus Infections* / pathology
Prognosis
Retrospective Studies

Grants and funding

Prendergast Research Fellowship Fund in Head and Neck Oncologic and Reconstructive Surgery