title: Impact of comorbidity and anemia in patients with oropharyngeal cancer primarily treated with surgery in the human papillomavirus era.
abstract: Comorbidity and anemia strongly influence treatment and outcome of oropharyngeal squamous cell carcinomas (SCCs), but respective data are frequently lacking in clinical studies. We evaluated 149 cases of oropharyngeal SCC primarily treated with surgery regarding the impact of these factors on disease-free survival (DFS) and overall survival (OS).
  
  
  
  Data were recorded during treatment and follow-up visits. Human papillomavirus (HPV) association of oropharyngeal SCC was detected by p16 immunohistochemistry.
  
  
  
  Patients with p16-positive disease were significantly less comorbid and anemic, and treated more aggressively. Comorbidity and anemia, but not p16 status, significantly influenced DFS and had more impact on OS than p16 status.
  
  
  
  In our study, p16-positive seems a good surrogate marker for healthier patients. Patients with p16-positive disease showed improved survival, but this was limited to none/mild comorbid and/or nonanemic individuals in this group. On the basis of our results, we strongly suggest the inclusion of these factors in risk stratification for clinical studies. © 2016 Wiley Periodicals, Inc. Head Neck 39: 7-16, 2017.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians University, Munich, Germany.|Clinical Cooperation Group, Personalized Radiotherapy in Head and Neck Cancer, Helmholtz Zentrum, Munich, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Baumeister
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Josepha
authors.initials: J
authors.lastname: Rauch
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Jacobi
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kisser
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Betz
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Becker
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications* / Q000401:mortality / Q000821:virology; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery* / Q000821:virology*; D015331:Cohort Studies; D019941:Cyclin-Dependent Kinase Inhibitor p16; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000601:surgery* / Q000821:virology*; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications* / Q000401:mortality; D015996:Survival Rate
chemical_list: D019941:Cyclin-Dependent Kinase Inhibitor p16
keywords: anemia; comorbidity; human papillomavirus (HPV); oropharyngeal squamous cell carcinoma (SCC); p16