Extracapsular growth in HPV positive oropharyngeal cancer

Introduction The favourable prognosis of HPV-positive oropharyngeal carcinoma (OPSCC) is clearly reflected in the 8th edition of TNM. However, literature results show inconsistent results regarding the prognostic relevance of extracapsular growth (ENE) of lymph node metastases in HPV-positive OPSCC.

Method Database analysis of primary operated patients with OPSCC (ED 2008-2015). Descriptive data, risk factors, TNM / UICC, and outcome were collected. HPV determination was carried out using p16-IHC. ENE was documented according to histological findings. In addition, a selective review of the literature focused on the prognostic relevance of ENE in HPV-positive OPSCC was performed.

Results. The subgroup included 95 patients (total collective n = 255). In HPV-negative tumors, the significant prognosis deterioration by ENE was confirmed. HPV-positive OPSCC with negative ENE showed significantly better 5-year OS (92.9 % vs. 68.0 %, p = 0.008). Bauer et al. (Laryngoscope, 2019, n = 4153, National Cancer Database, USA) also demonstrated that ENE is associated with significant worsening of OS in HPV-positive OPSCC (univariate: 5-year OS: 84 % vs. 92.6 % ; p <0.001, multivariate: HR: 1.9 at ENE +; p <0.001).

Conclusion The results of our work and recent publications contrast with the assessment of a lack of prognostic relevance of ENE in HPV-positive OPSCC in the 8th edition of TNM. Due to the data, interdisciplinary teams in tumor conferences should not be tempted to deescalate the therapy. An international standardization of imaging and histological diagnosis (micro- and macroscopic), as well as the documentation of ENE should be aspired.

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Publication History

Article published online:
10 June 2020