A benchmark for oncologic outcomes and model for lethal recurrence risk after transoral robotic resection of HPV-related oropharyngeal cancers.

Benchmarking Head and Neck Neoplasms / etiology Humans Neoplasm Recurrence, Local / epidemiology Oropharyngeal Neoplasms / pathology Papillomavirus Infections Retrospective Studies Robotic Surgical Procedures / adverse effects
Distant metastasis HPV Head and Neck cancer Head and neck squamous cell carcinoma Oropharyngeal cancer TORS

Journal

Oral oncology
ISSN: 1879-0593
Titre abrégé: Oral Oncol
Pays: England
ID NLM: 9709118

Informations de publication

Date de publication:
04 2022
Historique:
received: 19 09 2021
revised: 16 01 2022
accepted: 24 02 2022
pubmed: 5 3 2022
medline: 6 4 2022
entrez: 4 3 2022
Statut: ppublish

Résumé

Increasing use of transoral robotic surgery (TORS) is likely to impact outcomes for HPV+ oropharyngeal squamous cell carcinomas (OPSCCs). We aimed to describe oncologic outcomes for a large HPV+ OPSCC cohort after TORS and develop a risk prediction model for recurrence under this treatment paradigm. 634 HPV+ OPSCC patients receiving TORS-based therapy at a single institution were reviewed retrospectively to describe survival across the entire cohort and for patients suffering recurrence. Risks for distant metastatic recurrence (DMR) and locoregional recurrence (LRR) were modeled using multivariate logistic regression analyses of case-control sub-cohorts. 5-year overall and recurrence-free survival were 91.2% and 86.1%, respectively. 5-year overall survival was 52.5% following DMR and 83.3% after isolated LRR (P = .01). In case-control analyses, positive surgical margins were associated with DMR (adjusted OR 5.8, CI 2.1-16.0, P = .001), but not isolated LRR, and increased DMR risk 4.2 fold in patients with early clinical stage disease. By contrast, LRR was associated with not receiving recommended adjuvant therapy (OR 13.4, CI 6.3-28.5, P < .001). This study sets a benchmark for oncologic outcomes from HPV+ OPSCC after TORS-based therapy. Under this treatment paradigm, margins are relevant for assessing lethal recurrence risk during clinical trial design and post-treatment surveillance.

Identifiants

DOI: 10.1016/j.oraloncology.2022.105798 PMID: 35245888 PMC: PMC9288202
pubmed: 35245888
pii: S1368-8375(22)00087-2
doi: 10.1016/j.oraloncology.2022.105798
pmc: PMC9288202
mid: NIHMS1785262
pii:
doi:

Types de publication

Journal Article Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

105798

Subventions

Organisme : NIDCR NIH HHS
ID : R01 DE027185
Pays : United States

Informations de copyright

Copyright © 2022 Elsevier Ltd. All rights reserved.

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Auteurs

Robert M Brody (RM)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States; Department of Biostatistics Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Robert.Brody2@pennmedicine.upenn.edu.

David Shimunov (D)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: David.Shimunov@pennmedicine.upenn.edu.

Roger B Cohen (RB)

Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Roger.Cohen@pennmedicine.upenn.edu.

Alexander Lin (A)

Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Alexander.Lin2@pennmedicine.upenn.edu.

John N Lukens (JN)

Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: John.Lukens@pennmedicine.upenn.edu.

Lee Hartner (L)

Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: lee.hartner@pennmedicine.upenn.edu.

Charu Aggarwal (C)

Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: charu.aggarwal@pennmedicine.upenn.edu.

Umamaheswar Duvvuri (U)

Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, United States. Electronic address: duvvuriu@upmc.edu.

Kathleen T Montone (KT)

Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: kathleen.montone@pennmedicine.upenn.edu.

Jalal B Jalaly (JB)

Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: jalal.jalaly@pennmedicine.upenn.edu.

Virginia A LiVolsi (VA)

Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: linus@pennmedicine.upenn.edu.

Ryan M Carey (RM)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Ryan.Carey@pennmedicine.upenn.edu.

Rabie M Shanti (RM)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: rabie.shanti@pennmedicine.upenn.edu.

Karthik Rajasekaran (K)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Karthik.Rajasekaran@pennmedicine.upenn.edu.

Ara A Chalian (AA)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Ara.Chalian@pennmedicine.upenn.edu.

Christopher H Rassekh (CH)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Christopher.Rassekh@pennmedicine.upenn.edu.

Steven B Cannady (SB)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Steven.Cannady@pennmedicine.upenn.edu.

Jason G Newman (JG)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Jason.Newman@pennmedicine.upenn.edu.

Bert W O'Malley (BW)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: bert.omalley@umm.edu.

Gregory S Weinstein (GS)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Gregory.Weinstein@uphs.upenn.edu.

Phyllis A Gimotty (PA)

Department of Biostatistics Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: pgimotty@pennmedicine.upenn.edu.

Devraj Basu (D)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: devraj.basu@uphs.upenn.edu.

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