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conducted in SAS version 9.3 (SAS Institute, Cary, NC)
or the R language environment for statistical computing
(R version 3.1.0).
RESULTS
From January 1, 2002, to August 31, 2012, a total of
296 previously untreated patients with oropharyngeal
SCC underwent surgical resection for curative intent at
the Arthur G. James Cancer Hospital and Richard J.
Solove Research Institute. Patient demographic and clini-
cal characteristics are summarized in Table 1.
The vast majority of patients were p16-positive (77.1%)
and 168 patients (58.5%) were confirmed to be both p16-
positive and HPV-positive. Fifty-three patients were p16-
positive/HPV-negative by in situ hybridization and 3 were
p16-negative/HPV-positive. With regard to surgical
approach, 58.8% underwent transoral and 41.2% had
open surgical approaches for tumor extirpation.
Overall survival
Overall 1-, 3-, and 5-year survival rates for all patients,
regardless of HPV status, were 88.5%, 71.3%, and 65.1%,
respectively. HPV-positive patients had better overall sur-
vival than HPV-negative patients (log-rank
p
value
<
.0001; see Figure 1). HPV-positive patients had overall
survival rates of 94.2%, 83.3%, and 81.8% at 1, 3, and 5
years compared to 79.5%, 53.3%, and 40.3% for HPV-
negative patients.
TABLE 1. Patient characteristics.
Characteristics
No. of patients (%)
Age, y, mean (SD)
57.8 (9.2)
Marital status
Single/divorced/widowed
115 (41.8)
Married
160 (58.2)
Race
African American/black
12 (4.1)
White
281 (95.9)
Sex
Female
61 (20.6)
Male
235 (79.4)
Smoking status
10 pack-years
82 (29.0)
>
10 pack-years
201 (71.0)
Approach
TORS
84 (28.4)
Transoral, nonrobotic
90 (30.4)
Transcervical (eg, suprahyoid)
37 (12.5)
Mandibulotomy
50 (16.9)
Composite resection
35 (11.8)
ECS
No
175 (61.2)
Yes
111 (38.8)
HPV status
Negative
117 (40.5)
Positive
172 (59.5)
Mucosal margins
Free of carcinoma
239 (81.6)
Positive margins
54 (18.4)
N classification
N0
38 (12.9)
N1
57 (19.4)
N2
186 (63.3)
N3
13 (4.4)
p16 status
Negative
66 (22.9)
Positive
222 (77.1)
Perineural invasion
No
209 (71.8)
Yes
82 (28.2)
Primary site
Base of tongue
74 (25.1)
Other
23 (7.8)
Tonsil
198 (67.1)
Rick group, HPV
Low
106 (38.4)
Intermediate
69 (25.0)
High
101 (36.6)
Rick group, p16
Low
129 (46.9)
Intermediate
85 (30.9)
High
61 (22.8)
TNM stage
I
11 (3.7)
II
12 (4.1)
III
62 (21.1)
IV
209 (71.1)
T classification
T1
77 (26.0)
T2
126 (42.6)
T3
48 (16.2)
T4
45 (15.2)
Abbreviations: TORS, transoral robotic surgery; ECS, extracapsular extension; HPV, human
papillomavirus.
FIGURE 1. Kaplan–Meier estimates of survival according to
human papillomavirus (HPV) status. Patients with HPV-positive
tumors had significantly better overall survival than patients with
HPV-negative tumors (
p
<
.0001).
K
UMAR ET AL
.
HEAD & NECK—DOI 10.1002/HED APRIL 2016
161