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Scientific Oral Presentations

Head and Neck Surgery

Session: Scientific Oral Presentations 4 - Head and Neck Surgery

Adverse Pathological Prognostic Factors in Surgically Treated HPV-Positive Oropharyngeal Squamous Cell Carcinoma

Sunday, September 29, 2024
1:24 PM – 1:30 PM EDT
Location: MBCC, 208
Disclosure(s):
Salma Ramadan, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Angela L. Mazul, PhD, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jose P. Zevallos, MD, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Ryan S. Jackson, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Sidharth V. Puram, MD, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Controversy exists around the utility of extra-nodal extension (ENE) and positive surgical resection margins (PSM) in HPV+ Oropharyngeal Squamous Cell Carcinoma (OPSCC). Our study evaluates their role in survival, disease recurrence, and their interaction with other risk factors.

Methods: In this retrospective cohort study, pathology reports and charts of 254 patients undergoing surgical resection for HPV+ OPSCC between 2015 and 2021 were reviewed for data on surgical margins, ENE, survival, and recurrence. Survival analyses were done using a Cox Proportional hazards regression model. Associations between pathological factors were assessed using chi-square tests.

Results: Worse disease-specific survival was associated with ≥5 metastatic nodes [HR= 8.2, 95% CI 3.1-22.1], positive ENE [HR= 4.5, 95% CI 1.3-15.7], PSM [HR= 3.3, 95% CI 1.1-10.1], and repeated margin clearance attempts [HR= 3.4, 95% CI 1.1-10.7]. Locoregional recurrence was associated with ≥5 metastatic nodes [HR= 7, 95% CI 1.7-27.9] and PSM [HR= 6.1, 95% CI 1.4-25.6]. PSM was associated with advanced T stage and base of tongue primaries. ENE was associated with LVI, perineural invasion (PNI), ≥5 metastatic nodes, and tonsil primaries.

In early T stage OPSCC, ≥5 metastatic nodes [HR= 5.5, 95% CI 1.7-18.2], ENE [HR= 11.4, 95% CI 1.5-88.9] and PSM [HR=4.8, 95% CI 1.3-18.1] were associated with worse disease specific survival. Locoregional recurrence was associated with ≥5 metastatic nodes [HR= 5.4, 95% CI 1.2-24.1] and PSM [HR= 11.8, 95% CI 2.6-53.5]. On multivariable analysis ENE [HR= 11, 95% CI 1.4-86.3], and PSM [HR= 4.4, 95% CI 1.2-16.5] were associated with worse disease specific survival. In advanced T-stage OPSCC, only the presence of ≥5 metastatic nodes was associated with worse disease specific survival.

Conclusions: Both PSM (despite being associated with higher T stages) and ENE independently predict worse disease specific survival and locoregional recurrence particularly in early-stage HPV+ OPSCC. ENE was not associated with advanced T stage, PSM, or repeated attempts to clear margins, suggesting an independent pathological process.

    Presenting Author(s)

  • Salma Ramadan, MD

    Clinical research coordinator
    Washington University in Saint Louis
    Saint louis, MO, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • AM

    Angela L. Mazul, PhD, MPH

    Assistant Professor
    University of Pittsburgh Medical Center, Department of Otolaryngology - Head and Neck Surgery
    Pittsburgh, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • RP

    Randal C. Paniello, MD, PhD

    Professor
    Washington University in Saint Louis
    St. Louis, Missouri, United States

    Disclosure information not submitted.

  • Jose P. Zevallos, MD, MPH

    Professor & Chairman, Department of Otolaryngology The Eugene N. Myers, M.D., Professor and Chairman
    Department of Otolaryngology – Head and Neck Surgery, University of Pittsburgh, Medical Center
    Pittsburgh, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • PP

    Patrik Pipkorn, MD

    Associate professor
    Washington University-BJH/SLCH Consortium, Department of Otolaryngology - Head and Neck Surgery
    St. Louis, MO, United States

    Disclosure information not submitted.

  • RJ

    Ryan S. Jackson, MD

    Associate Professor
    Washington University School of Medicine
    St. Louis, MO, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Sidharth V. Puram, MD, PhD

    Chief of Head and Neck Surgery, Director of Rob Ebert and Greg Stubblefield Head and Neck Tumor Center at Siteman, Associate Professor
    Washington University School of Medicine
    St. Louis, MO, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.