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, 50 (1), 45-51

Distant Metastasis in p16-positive Oropharyngeal Squamous Cell Carcinoma: A Critical Analysis of Patterns and Outcomes

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Distant Metastasis in p16-positive Oropharyngeal Squamous Cell Carcinoma: A Critical Analysis of Patterns and Outcomes

P Sinha et al. Oral Oncol.

Abstract

Objective: With good loco-regional control, disease failure in p16-positive oropharyngeal squamous cell carcinoma (OPSCC) mainly results from distant metastasis (DM). Our objective was to characterize the patterns and clinical outcomes of DM in p16-positive OPSCC and compare these to patients with p16-negative disease.

Methods: Primary OPSCC patients who developed DM after completing surgical or non-surgical treatment were identified and p16 status was evaluated. Patterns of DM and post-DM progression-free (PFS) and disease-specific survival (DSS) were assessed.

Results: Forty-one of the 66 (62%) patients with DM were p16-positive. DM patterns were not statistically different by p16 status. However, p16-positive patients developed DM later in their course and had longer survival. All p16-negative patients either had progression or died within 24 months of DM detection whereas the 2-year post-DM PFS in the p16-positive group was 20% (95% CI: 8-32.5%, p=0.003). The 3-year post-DM disease-specific survival (DSS) estimate in the p16-positive patients was 16% (95% CI: 7-18%) while all p16-negative patients died within 34 months (p<0.001). p16-negativity, loco-regional disease, and no/palliative versus curative intent treatment were all associated with reduced post-DM DSS in multivariate analysis.

Conclusions: The DM pattern did not differ remarkably between p16-positive and negative OPSCC patients in our practice. In p16-positive OPSCC with pulmonary oligometastatic disease, curative intent treatment and optimized locoregional control for the index primary prolonged survival.

Keywords: Distant metastasis; Human papillomavirus; Oligometastasis; Oropharynx carcinoma; p16-Positive.

Figures

Figure 1
Figure 1
Histologic features of nonkeratinizing squamous cell carcinoma with distant metastasis to the lung. A – Low power (4× magnification), and B) High power (inset shows p16 staining) (both 20× magnification).
Figure 2
Figure 2
Kaplan Meier estimates for (A) Post-Distant Metastasis Disease-specific survival (p=<0.001), (B) Post-Distant Metastasis Progression-free survival by p16 status (p=0.003)
Figure 3
Figure 3
Kaplan Meier estimates for Post-Distant Metastasis Disease-specific survival in p16-positive patients by types of therapy (p=<0.001)

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