Affiliation:
1. Mayo Clinic Alix School of Medicine Rochester Minnesota U.S.A.
2. Mayo Clinic Department of Quantitative Health Sciences Rochester Minnesota U.S.A.
3. Mayo Clinic Department of Otolaryngology—Head and Neck Surgery Rochester Minnesota U.S.A.
Abstract
ObjectivesThis study examines oncologic outcomes in patients with HPV‐related oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) who had evidence of gross cranial nerve invasion (CNI) identified at the time of surgery.Study DesignRetrospective cohort study comparing demographics, clinical features, and outcomes of HPV(+)OPSCC patients with and without gross CNI.MethodsPatients with biopsy proven HPV(+)OPSCC involving the base of tongue, tonsil, or unknown primary site, who underwent surgery as a part of their treatment between 1/1/2006–12/31/2020 (n = 874), were included in this study. Gross CNI was identified during operative intervention (n = 36). Statistical analyses were performed using SAS version 9.4 and R version 3.6.2. P‐values <0.05 were considered statistically significant.ResultsHPV(+)OPSCC patients with gross CNI were nearly 5 times as likely to suffer death by cancer (HR = 5.41, 95% CI 2.51 to 11.67, p < 0.0001), over 4 times as likely to see disease progression (HR = 4.25, 95% CI 2.31 to 7.84, p < 0.0001), and nearly 5 times as likely to experience metastasis (HR = 4.46, 95% CI 2.20 to 9.06, p < 0.0001) when compared to patients without CNI. Patients with gross CNI had significantly lower overall survival, cancer‐specific survival, progression‐free survival, and distant‐metastasis free survival (p < 0.0001). Patients with gross CNI were significantly more likely to present with higher clinical N stage, higher pathological N stage and extracapsular spread than patients without gross CNI.ConclusionsOur findings indicate that the presence of CNI is associated with significantly poorer oncologic outcomes in HPV(+)OPSCC patients.Level of Evidence3 Laryngoscope, 134:170–177, 2024