HPV-related oropharyngeal cancer: Risk factors for treatment failure in patients managed with primary transoral robotic surgery

Head Neck. 2016 Jan;38(1):59-65. doi: 10.1002/hed.23850. Epub 2015 Apr 6.

Abstract

Background: The purpose of this study was to determine clinical factors that predict locoregional recurrence or distant metastasis in patients with human papillomavirus (HPV)-positive oropharyngeal cancer treated with surgery and guideline-indicated adjuvant therapy.

Methods: We identified all presumed HPV-positive patients with oropharyngeal cancer in our health system from January 2010 to August 2012 treated with surgery and guideline-indicated adjuvant therapy. Statistical analysis was performed to identify clinical predictors associated with treatment failure.

Results: One hundred fourteen p16+ oropharyngeal cancers managed with initial surgical resection were identified. Median follow-up was 17 months. Two-year locoregional failure was 3.3% and distant failure was 8.4%. Statistical analysis found that conventional poor prognostic features did not predict treatment failure.

Conclusion: Locoregional recurrence and development of distant metastatic disease are uncommon in patients who are appropriately selected for surgical management of p16+ oropharyngeal cancer regardless of the presence or absence of conventional poor prognostic features.

Keywords: human papillomavirus (HPV); oropharyngeal; p16; prognostic factors; transoral robotic surgery (TORS).

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy
  • Carcinoma, Squamous Cell / virology*
  • Chemoradiotherapy, Adjuvant / methods
  • Female
  • Follow-Up Studies
  • Human papillomavirus 16* / isolation & purification
  • Humans
  • Immunocompromised Host*
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / therapy
  • Neoplasm Recurrence, Local / virology*
  • Oropharyngeal Neoplasms / mortality
  • Oropharyngeal Neoplasms / pathology
  • Oropharyngeal Neoplasms / therapy
  • Oropharyngeal Neoplasms / virology*
  • Papillomavirus Infections / complications*
  • Retrospective Studies
  • Risk Factors
  • Robotic Surgical Procedures* / methods
  • Smoking / adverse effects
  • Treatment Failure