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Impact of p16 expression in oropharyngeal cancer in the postoperative setting: the necessity of re-evaluating traditional risk stratification

 Jeongshim Lee  ;  Jee Suk Chang  ;  Hyung Joo Kwon  ;  Se-Heon Kim  ;  Sang Joon Shin  ;  Ki Chang Keum 
 Japanese Journal of Clinical Oncology, Vol.46(10) : 911-918, 2016 
Journal Title
 Japanese Journal of Clinical Oncology 
Issue Date
Adult ; Aged ; Carcinoma, Squamous Cell/mortality ; Carcinoma, Squamous Cell/pathology* ; Carcinoma, Squamous Cell/radiotherapy ; Disease-Free Survival ; Female ; Human papillomavirus 16/isolation & purification ; Human papillomavirus 16/metabolism ; Humans ; Immunohistochemistry ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Oropharyngeal Neoplasms/mortality ; Oropharyngeal Neoplasms/pathology* ; Oropharyngeal Neoplasms/radiotherapy ; Papillomavirus Infections/complications ; Papillomavirus Infections/pathology ; Papillomavirus Infections/virology ; Postoperative Period ; Prognosis ; Retrospective Studies ; Risk Factors ; Survival Rate ; Viral Proteins/genetics ; Viral Proteins/metabolism*
HPV ; oropharyngeal squamous cell carcinoma ; p16 ; postoperative setting ; risk stratification
OBJECTIVE: To evaluate the impact of p16 expression as a surrogate marker of human papillomavirus status in oropharyngeal squamous cell carcinoma patients underwent surgery followed by postoperative radiotherapy. METHODS: We identified 126 consecutive patients with histologically confirmed, newly diagnosed oropharyngeal squamous cell carcinoma who received surgery followed by radiotherapy and had p16 expression data available. All patients were treated between 2001 and 2011. Patients with high-risk factors (positive surgical margin and/or extracapsular extension) or other risk factors (multiple positive lymph nodes, perineural/lymphovascular invasion) were offered postoperative radiotherapy with or without concurrent chemotherapy. RESULTS: One hundred and four (82.5%) patients were p16-positive (p16 (+)) and 22 (17.5%) were p16-negative (p16 (-)). With a median follow-up of 56 months, patients with p16 (+) oropharyngeal squamous cell carcinoma exhibited a significantly better 5-year disease-free survival (80.7% vs. 57.6%, P < 0.001) and overall survival (84.9% vs. 59.1%, P < 0.001) than those with p16 (-) tumors. The p16 (+) oropharyngeal squamous cell carcinoma with high-risk factors (n = 64) showed no difference in disease-free survival (79.7% vs. 68.3%; P = 0.531) and overall survival (82.1% vs. 76.2%; P = 0.964) between postoperative radiotherapy and postoperative radiotherapy with concurrent chemotherapy. CONCLUSIONS: Expression of p16 is a strong independent prognostic factor of survival in the postoperative setting of oropharyngeal squamous cell carcinoma. The favorable prognosis of p16 (+) oropharyngeal squamous cell carcinoma suggests a need to re-examine traditional risk stratification for determining optimal adjuvant treatment.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Otorhinolaryngology (이비인후과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Kim, Se Heon(김세헌)
Shin, Sang Joon(신상준) ORCID logo https://orcid.org/0000-0001-5350-7241
Lee, Jeong Shim(이정심)
Chang, Jee Suk Paul(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
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