Nomogram for preoperative prediction of nodal extracapsular extension or positive surgical margins in oropharyngeal squamous cell carcinoma

• Published in: Oral oncology Vol. 83; pp. 73 - 80
• Main Authors: Hararah, Mohammad K., Stokes, William A., Jones, Bernard L., Oweida, Ayman, Ding, Ding, McDermott, Jessica, Goddard, Julie, Karam, Sana D.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2018
• Subjects: Adjuvant; Aged; Alphapapillomavirus - isolation & purification; Carcinoma; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Carcinoma, Squamous Cell - virology; Chemoradiotherapy; Decision making; Female; Head and neck cancer; Human papillomavirus (HPV); Humans; Lymph nodes; Lymphatic Metastasis; Male; Margins of Excision; Nomograms; Oropharyngeal cancer; Oropharyngeal Neoplasms - pathology; Oropharyngeal Neoplasms - surgery; Oropharyngeal Neoplasms - virology; Preoperative Period; Radiation therapy; Squamous cell; Surgical margins; Carcinoma; Squamous cell; Decision making; Oropharyngeal cancer; Head and neck cancer; Surgical margins; Adjuvant; Human papillomavirus (HPV); Radiation therapy; Chemoradiotherapy; Lymph nodes
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2018.06.005

•Largest analysis of surgically treated HPV positive oropharyngeal SCC.•Preoperative factors predict pathologic extracapsular extension or positive surgical margins.•Preoperative clinical factors include N-staging, T-staging, age, and tumor grade.•Nomogram was built and internally validated for HPV positive and negative patients.•Nomograms may help guide clinical decisions and encourage shared-decision making. Extracapsular extension (ECE) in regional lymph nodes and positive surgical margins (PSM) are considered high-risk adverse pathologic features in patients with oropharyngeal squamous cell carcinoma (OPSCC) that each constitute an indication for postoperative adjuvant chemoradiation. We identify pre-operative clinical factors that can predict post-operative ECE and/or PSM and create a nomogram to help clinical decision making. Adult patients with non-metastatic OPSCC with initial surgical treatment and confirmed HPV status diagnosed between 2010 and 2014 were selected from the National Cancer Database. Clinical staging was modified to American Joint Committee on Cancer 8th edition parameters. Logistic regression was used for multivariate analysis to identify predictors of pathologic ECE and/or PSM. 5065 patients were included. 47.5% of the 3336 HPV-positive (HPV+) patients had ECE/PSM. 40.4% of the 1729 HPV-negative (HPV−) patients with had ECE/PSM. A model was built that included age, clinical ECE, tumor grade, and clinical T and N staging for HPV+ patients. Increasing N-classification was highly predictive of pathologic ECE and/or PSM (N1 OR = 3.6, N2 OR = 7.0, N3 OR = 11.2, p < 0.01). Clinical ECE (OR = 4.1, p < 0.01), tumor grade (ORs 2.2–4.4 with p < 0.05), and increasing clinical T-classification (ORs 1.2–1.8, p < 0.05) were also associated with ECE and/or PSM. A similar model was built for HPV− with similar predictive capability. Two internally validated nomograms were designed that demonstrated good discrimination (HPV+ AUC = 0.66, 95% CI: 0.64–0.68, and HPV− AUC = 0.70, 95% CI: 0.67–0.72) and good calibration (goodness-of-fit statistic of HPV+ 6.32, p = 0.61 and HPV− 11.66, p = 0.17). These are the first nomograms designed to help predict ECE or PSM for both HPV+ and HPV− OPSCC. The nomograms can facilitate shared decision-making between clinicians and patients as they consider upfront treatment selection for OPSCC.