Risk stratification after recurrence of human papillomavirus (HPV)-related and non-HPV-related oropharyngeal cancer: Secondary analysis of NRG Oncology RTOG 0129 and 0522

Head Neck. 2022 Jan;44(1):158-167. doi: 10.1002/hed.26915. Epub 2021 Nov 3.


Background: No risk-stratification strategies exist for patients with recurrent oropharyngeal cancer (OPC).

Methods: Retrospective analysis using data from prospective NRG Oncology clinical trials RTOG 0129 and 0522. Eligibility criteria included known p16 status and smoking history, and locoregional/distant recurrence. Overall survival (OS) was measured from date of recurrence. Recursive partitioning analysis was performed to produce mutually exclusive risk groups.

Results: Hundred and fifty-four patients were included with median follow-up after recurrence of 3.9 years (range 0.04-9.0). The most important factors influencing survival were p16 status and type of recurrence, followed by surgical salvage and smoking history (≤20 vs. >20 pack-years). Three significantly different risk groups were identified. Patients in the low-, intermediate-, and high-risk groups had 2-year OS after recurrence of 81.1% (95%CI 68.5-93.7), 50.2% (95%CI 36.0-64.5), and 20.8% (95%CI 10.5-31.1), respectively.

Conclusion: Patient and tumor characteristics may be used to stratify patients into risk groups at the time of OPC recurrence.

Keywords: Radiation Therapy Oncology Group; human papillomavirus; recurrent oropharyngeal cancer; recursive partitioning analysis; survival.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Alphapapillomavirus*
  • Humans
  • Neoplasm Recurrence, Local / epidemiology
  • Oropharyngeal Neoplasms* / therapy
  • Papillomaviridae
  • Papillomavirus Infections* / complications
  • Papillomavirus Infections* / epidemiology
  • Prospective Studies
  • Retrospective Studies
  • Risk Assessment