Outcome and Prognostic Factors in T4a Oropharyngeal Carcinoma, Including the Role of HPV Infection

[摘要] Background. The prognosis of patients with advanced oropharyngeal carcinoma (OPSCC) is generally poor. The aim of this study is to investigate the different therapeutic approaches and identify prognostic factors associated with a worse outcome for patients treated for T4a OPSCC, in order to improve treatment selection for the individual.Methods. A retrospective study was conducted on 426 patients with T4a OPC treated between 1980 and 2010. Eleven prognostic factors including treatment modality, lymph node staging, and p16 status as a surrogate marker for human papillomavirus (HPV) infection were analyzed.Results. Univariate analysis showed a significant difference in DSS between N0 and N+ (57.1% versus 26.9%,P<0.001), primary surgical and primary nonsurgical treatment (52.7% versus 31.4%,P<0.001), and perinodal invasion (51.7% versus 19.9%,P=0.011). P16-negative patients tended towards a worse DSS than p16-positive patients (40.2% versus 64.6%,P=0.126) but responded better to primary surgery than to nonsurgical treatment (71.4% versus 34.0%,P=0.113). Multivariate analysis identified the N category as an independent prognostic factor for survival.Conclusion. The survival of p16-negative patients was worse than p16-positive patients, although they seem to respond better to primary surgery. The strongest independent prognostic factor for T4a carcinomas proved to be the presence of lymph node metastases.

[学科分类] 基础医学