Extracapsular extension, pathologic node status, and adjuvant treatment in primary surgery patients with human papillomavirus-mediated oropharyngeal cancer: National hospital-based retrospective cohort analysis

Andrew T. Day, Alex M. Yang, Priscilla Tanamal, James Michael Blackwell, Ellen Wang, Baran D. Sumer, Justin A. Bishop, Randall S. Hughes, Saad Khan, David J. Sher

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)3345-3363
Number of pages19
JournalHead and Neck
Volume43
Issue number11
DOIs
StatePublished - Nov 2021

Keywords

  • extracapsular extension
  • human papillomavirus
  • oropharyngeal cancer
  • survival
  • treatment paradigm

ASJC Scopus subject areas

  • Otorhinolaryngology

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