Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States.
Department of Radiation Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States.
Oral Oncol. 2021 Jan;112:105046. doi: 10.1016/j.oraloncology.2020.105046. Epub 2020 Oct 28.
Patients with human papillomavirus (HPV) associated squamous cell carcinoma of the oropharynx (SCC-OP) have improved overall survival (OS) after distant metastasis (DM) compared to HPV negative patients. These patients may be appropriate candidates for enrollment on clinical trials evaluating the efficacy of metastasis-directed therapy (MDT). This study seeks to identify prognostic factors associated with OS after DM, which could serve as enrollment criteria for such trials.
From an IRB approved multi-institutional database, we retrospectively identified patients with HPV/p16 positive SCC-OP diagnosed between 2001 and 2018. Patterns of distant failure were assessed, including number of lesions at diagnosis and sites of involvement. The primary outcome was OS after DM. Prognostic factors for OS after DM were identified with Cox proportional hazards. Stepwise approach was used for multivariable analysis.
We identified 621 patients with HPV-associated SCC-OP, of whom 82 (13.2%) were diagnosed with DM. Median OS after DM was 14.6 months. On multivariable analysis, smoking history and number of lesions were significantly associated with prolonged OS. Median OS after DM by smoking (never vs ever) was 37.6 vs 11.2 months (p = 0.006), and by lesion number (1 vs 2-4 vs 5 or more) was 41.2 vs 17.2 vs 10.8 months (p = 0.007).
Among patients with newly diagnosed metastatic HPV-associated SCC-OP, lesion number and smoking status were associated with significantly prolonged overall survival. These factors should be incorporated into the design of clinical trials investigating the utility of MDT, with or without systemic therapy, in this population.
与 HPV 阴性患者相比，人乳头瘤病毒（HPV）相关的口咽鳞状细胞癌（SCC-OP）患者在出现远处转移（DM）后总体生存（OS）得到改善。这些患者可能适合入组评估转移导向治疗（MDT）疗效的临床试验。本研究旨在确定与 DM 后 OS 相关的预后因素，这些因素可作为此类试验的入组标准。
从经机构审查委员会批准的多机构数据库中，我们回顾性地确定了 2001 年至 2018 年间诊断为 HPV/p16 阳性 SCC-OP 的患者。评估了远处失败的模式，包括诊断时的病变数量和受累部位。主要结局是 DM 后的 OS。使用 Cox 比例风险确定 DM 后 OS 的预后因素。采用逐步法进行多变量分析。
我们确定了 621 例 HPV 相关 SCC-OP 患者，其中 82 例（13.2%）被诊断为 DM。DM 后的中位 OS 为 14.6 个月。多变量分析显示，吸烟史和病变数量与延长 OS 显著相关。DM 后吸烟（从不吸烟与吸烟）的中位 OS 分别为 37.6 个月和 11.2 个月（p=0.006），病变数量（1 个 vs. 2-4 个 vs. 5 个或更多）分别为 41.2 个月、17.2 个月和 10.8 个月（p=0.007）。
在新诊断为转移性 HPV 相关 SCC-OP 的患者中，病变数量和吸烟状况与总生存显著延长相关。这些因素应纳入评估 MDT （联合或不联合系统治疗）在该人群中的效用的临床试验设计中。
