Disease Profile and Oncologic Outcomes After Delayed Diagnosis of Human Papillomavirus–Associated Oropharyngeal Cancer

Linda X. Yin, Emily E. Karp, Anna Elias, Thomas J. O’Byrne, David M. Routman, Daniel L. Price, Jan L. Kasperbauer, Michelle Neben-Wittich, Ashish V. Chintakuntlawar, Katharine A. Price, Daniel J. Ma, Robert L. Foote, Eric J. Moore, Kathryn M. Van Abel

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Diagnostic delay in human papillomavirus–associated oropharynx squamous cell carcinoma (HPV(+)OPSCC) is common due to nonspecific symptoms. We aim to describe the disease burden and oncologic outcomes of patients with HPV(+)OPSCC diagnosed >12 months after symptom onset. Study Design: This is a retrospective cohort study of HPV(+)OPSCC patients receiving intent-to-cure treatment (including surgery ± adjuvant therapy or primary chemoradiation). Setting: 2006-2016, tertiary care center. Methods: Tumor stage was compared between patients with and without delayed diagnosis using χ2 tests. Kaplan-Meier survival analysis with univariate and multivariable Cox regressions were used to determine the effect of diagnostic delay on oncologic outcomes. Results: In total, 664 patients were included. Compared to patients diagnosed <12 months from symptom onset (n = 601), those diagnosed at >12 months (n = 63) were more likely to have T4 disease and higher overall American Joint Committee on Cancer (AJCC) clinical stage at presentation (P <.01 for both). At 5 years, rates of overall survival, cancer-specific survival, progression-free survival, and distant metastases–free survival in the delayed diagnosis cohort were 80%, 90%, 80%, and 89%, respectively. A >12-month delay in diagnosis did not significantly impact overall survival (adjusted hazard ratio [aHR], 1.16; 95% CI, 0.58-2.31), cancer-specific survival (aHR, 0.83; 95% CI, 0.29-2.39), progression-free survival (aHR, 1.15; 95% CI, 0.56-2.37), or distant metastases–free survival (aHR, 1.00; 95% CI, 0.42-2.40) after adjusting for age, sex, and clinical AJCC stage (P >.05 for all). Conclusions: Delayed diagnosis of HPV(+)OPSCC is associated with greater burden of disease at presentation, but oncologic outcomes remain favorable across treatment modalities. When appropriate, intent-to-cure therapy should be pursued despite diagnostic delay. Level of Evidence: Level III.

Original languageEnglish (US)
JournalOtolaryngology - Head and Neck Surgery (United States)
DOIs
StateAccepted/In press - 2021

Keywords

  • HPV
  • delayed diagnosis
  • diagnostic delay
  • human papillomavirus
  • oropharyngeal cancer
  • oropharynx
  • outcomes
  • prognosis
  • squamous cell

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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