TY - JOUR
T1 - Long-term analysis of transorally resected p16 + Oropharynx cancer
T2 - Outcomes and prognostic factors
AU - Sinha, Parul
AU - Haughey, Bruce H.
AU - Kallogjeri, Dorina
AU - Jackson, Ryan S.
PY - 2019/5
Y1 - 2019/5
N2 - 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.
AB - 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.
KW - Oropharynx cancer
KW - adjuvant therapy
KW - human papillomavirus
KW - p16 gene
KW - prognosis
UR - http://www.scopus.com/inward/record.url?scp=85053210986&partnerID=8YFLogxK
U2 - 10.1002/lary.27472
DO - 10.1002/lary.27472
M3 - Article
C2 - 30152175
AN - SCOPUS:85053210986
VL - 129
SP - 1141
EP - 1149
JO - Laryngoscope
JF - Laryngoscope
SN - 0023-852X
IS - 5
ER -