title: HPV-related oropharyngeal cancer: Risk factors for treatment failure in patients managed with primary transoral robotic surgery.
abstract: BACKGROUND
  The purpose of this study was to determine clinical factors that predict locoregional recurrence or distant metastasis in patients with human papillomavirus (HPV)-positive oropharyngeal cancer treated with surgery and guideline-indicated adjuvant therapy.
  
  
  METHODS
  We identified all presumed HPV-positive patients with oropharyngeal cancer in our health system from January 2010 to August 2012 treated with surgery and guideline-indicated adjuvant therapy. Statistical analysis was performed to identify clinical predictors associated with treatment failure.
  
  
  RESULTS
  One hundred fourteen p16+ oropharyngeal cancers managed with initial surgical resection were identified. Median follow-up was 17 months. Two-year locoregional failure was 3.3% and distant failure was 8.4%. Statistical analysis found that conventional poor prognostic features did not predict treatment failure.
  
  
  CONCLUSIONS
  Locoregional recurrence and development of distant metastatic disease are uncommon in patients who are appropriately selected for surgical management of p16+ oropharyngeal cancer regardless of the presence or absence of conventional poor prognostic features.
authors.affiliation: Department of Medical Oncology, Fox Chase Cancer Center/Temple University, Philadelphia, Pennsylvania.
authors.forename: John M
authors.initials: JM
authors.lastname: Kaczmar
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Kay See
authors.initials: KS
authors.lastname: Tan
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Heitjan
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lin
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Ahn
authors.affiliation: Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newman
authors.affiliation: Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Rassekh
authors.affiliation: Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Ara A
authors.initials: AA
authors.lastname: Chalian
authors.affiliation: Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Bert W
authors.initials: BW
authors.lastname: O'Malley
authors.affiliation: Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Roger B
authors.initials: RB
authors.lastname: Cohen
authors.affiliation: Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Weinstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy / Q000821:virology*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D052162:Human papillomavirus 16 / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy / Q000821:virology*; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy / Q000821:virology*; D030361:Papillomavirus Infections / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000379:methods; D012907:Smoking / Q000009:adverse effects; D017211:Treatment Failure
keywords: human papillomavirus (HPV); oropharyngeal; p16; prognostic factors; transoral robotic surgery (TORS)