Prognostic factors in oropharyngeal cancer – analysis of 627 cases receiving definitive radiotherapy

Figures & data

Table I.  Patient and treatment characteristics.

Age (years)	Median	56
	Range	24–86
Sex	Male	556 (88.7%)
	Female	71 (11.3%)
KPS	≥80	464 (74.1%)
	<80	163 (25.9%)
Prior history of tobacco abuse	Yes	505 (80.5%)
	No	122 (19.5%)
T stage	T1	36 (5.8%)
	T2	183 (29.2%)
	T3	301 (48.0%)
	T4	107 (17.1%)
N stage	N0	208 (33.2%)
	N2	153 (24.4%)
	N3	230 (36.7%)
	N4	36 (5.7%)
AJCC grouping	Stage I	16 (2.6%)
	Stage II	73 (11.6%)
	Stage III	237 (37.8%)
	Stage IV	301 (48%)
Primary subsite	Base of tongue	361(57.1%)
	Tonsil and soft palate	266 (42.4%)
Modality of treatment	Radiotherapy alone	446 (71.2%)
	Concomitant chemotherapy	145 (23.1%)
	Neoadjuvant chemotherapy	36 (5.7%)
Dose of Radiation	Median (Gy)	70
	<66 Gy	161 (25.7%)
	≥66 Gy	466 (74.3%)
Overall treatment time	Median (days)	50
	≤50 days	341 (54.3%)
	>50 days	286 (45.6%)
Chemotherapy	Single agent	137 (75.6%)
	Combination	44 (24.3%)

AJCC: American Joint Committee on Cancer; KPS: Karnofsky performance score.

Table II.  Patient and treatment characteristics on the basis of use of chemotherapy.

		RT + Chemotherapy	RT alone
Age (years)	Median	55	58
	Range	26–79	26–86
Sex	Male	90%	88%
	Female	10%	12%
KPS	≥80	76%	73%
	<80	24%	27%
AJCC grouping	Stage I	0%	3%
	Stage II	3%	15%
	Stage III	31%	41%
	Stage IV	66%	41%
Dose of Radiation	Median (Gy)	70	68
	<66 Gy	24%	28%
	≥66 Gy	76%	72%
Chemotherapy	Median	4
Compliance
(Cycles received)	Range	1–8

AJCC: American Joint Committee on Cancer; KPS: Karnofsky performance score; RT: Radiotherapy.

Figure 1.  Disease free survival and locoregional control in those with and without prior history of chronic tobacco abuse. The numbers tabulated below represent individuals at-risk at different time points.

Table III.  Univariate analysis of prognostic factors.

Variable	No.	3 yr DFS (SE)	P	3 yr LRC (SE)	p	3 yr LC (SE)	p
All patients	627	39.0% (2.4%)		40.6% (2.3%)		49.1% (2.5%)
Age
≤ 65 yrs	517	38.5% (2.6%)	0.78	40.3% (2.6%)	0.75	48.2% (2.7%)	0.55
> 65 yrs	110	41.8% (5.8%)		42.8% (5.8%)		53.8% (6.0%)
Gender
Male	556	38.0% (2.5%)	0.12	40.0% (2.5%)	0.18	48.0% (2.7%)	0.15
Female	71	46.1% 7.3%)		46.1% (7.3%)		57.2% (7.3%)
Tobacco abuse
Non abuser	122	50.9% (5.3%)	0.01	50.9% (5.3%)	0.03	56.8% (5.4%)	0.09
Abuser	505	35.9% (2.6%)		38.0% (2.7%)		47.1% (2.8%)
KPS
≥ 80	464	43.5% (2.8%)	0.03	45.3% (2.8%)	0.002	53.4% (2.9%)	0.001
< 80	163	27.4% (4.2%)		28.9% (4.2%)		38.3% (4.5%)
T stage
T1-2	216	49.4% (4.1%)	<0.001	52.5% (4.1%)	0.001	64.1% (4.0%)	<0.001
T3-4	411	33.8% (2.8%)		34.8% (2.8%)		41.6% (3.0%)
N stage
N0-1	361	49.5% (3.2%)	<0.001	50.8% (3.2%)	<0.001	56.1% (3.2%)	<0.001
N2-3	266	25.3% (3.3%)		27.2% (3.4%)		38.8% (4.0%)
Stage
I	16	80.4% (13.4%)		80.4% (13.4%)		93.8% (6.1%)
II	73	65.8% (6.6%)		65.8% (6.6%)		68.5% (6.6%)
III	237	46.1% (3.9%)	<0.001	48.0% (3.9%)	<0.001	54.3% (4.0%)	<0.001
IV	301	25.3% (3.1%)		27.0% (3.2%)		37.9% (3.7%)
Site of lesion
BOT and vallecula	361	36.4% (3.0%)	0.44	38.2% (3.0%)	0.45	48.6% (3.2%)	0.84
Tonsil and soft palate	266	43.7% (3.8%)		45.2% (3.8%)		51.5% (3.8%)
Treatment
Radical RT	446	38.3% (2.8%)		40.4% (2.9%)		48.2% (3.0%)
Conc CT+ RT	145	41.8% (4.8%)	0.81	42.4% (5.0%)	0.81	51.7% (4.8%)	0.91
Neoadjuvant CT + RT	36	32.7% (8.5%)		34.5% (8.8%)		45.2% (9.8%)
In patients ≥60Gy Dose of RT
< 66 Gy	128	31.6% (4.8%)	0.01	31.6% (4.8%)	0.005	41.8% (5.5%)	0.04
> 66Gy	460	42.5% (2.9%)		44.8% (2.8%)		52.9% (2.9%)
In patients ≥66Gy Overall treatment time
≤ 50 days	199	49.6% (4.3%)	0.01	54.0% (4.3%)	0.01	63.1% (4.3%)	0.004
> 50 days	261	37.2% (3.8%)		37.8% (3.8%)		45.5% (4.0%)

CT: chemotherapy; DFS: disease free survival; KPS: Karnofsky performance score; LC: local control; LRC: locoregional control; RT: radiotherapy.

Table IV.  Multivariate analysis of prognostic factors.

	Hazard Ratio (95% CI)	p
Disease-free Survival
Tobacco abuse (abuser vs. non-user)	1.54 (1.12–2.11)	0.008
KPS(<80 vs. ≥80)	1.29 (1.003–1.66)	0.047
N stage(N2-3 vs. N0-1)	1.84 (1.46–2.32)	<0.001
Dose range(<66 vs. ≥66 Gy)	1.47 (1.10–1.94)	0.008
OTT (>50 days vs. ≤50 days)	1.31 (1.02–1.68)	0.033
Locoregional Control
Tobacco abuse (abuser vs. non-user)	1.45 (1.06–1.99)	0.022
KPS(<80 vs. ≥80)	1.29 (1.002–1.67)	0.049
N stage(N2-3 vs. N0-1)	1.71 (1.34–2.12)	<0.001
Dose range(<66 vs. ≥66 Gy)	1.52 (1.14–2.02)	0.004
OTT (>50 days vs. ≤50 days)	1.32 (1.02–1.66)	0.033
Local Control
KPS(<80 vs. ≥80)	1.40 (1.06–1.86)	0.019
T stage (T3-4 vs. T1-2)	1.56 (1.14–2.13)	0.006
N stage(N2-3 vs. N0-1)	1.46 (1.12–1.91)	0.006
Dose range(<66 vs. ≥66 Gy)	1.48 (1.08–2.05)	0.016
OTT (>50 days vs. ≤50 days)	1.51 (1.14–2.00)	0.004

KPS: Karnofsky performance score; OTT: overall treatment time.

Table V.  Selected large series reporting results and/or prognostic factors after radical radiotherapy for oropharyngeal cancer.

Author (Date)	Subsite	Results	Independent prognostic factors
Jaulerry (1991) [7]	Base of tongue N = 166	OS: 3yr: 37% 2yr LC: T1 96%; T2 57%; T3 45%; T4 24%	T stage; histologic differentiation; response to RT at completion of treatment.
Perez (1998) [9]	Tonsil N = 384	10yr DFS: T1 65%; T2 60%; T3 60%; T4 30%	LC and DFS: T stage and N stage
Johansen (2000) [10]	Oropharynx N = 289	5yr LRC 38%; DFS 44%; OS 31%	DFS: T stage, N stage, gender.
Mendenhall (2006) [11]	Tonsil N = 503	5yr LC: T1 88%; T2 84%; T3 78%; T4 61% 5yr CSS: stage I, 100%; II 86%; III 84%; IVA 73%; IVB 46%	LC: T stage, primary site, and fractionation CSS: T stage, overall stage, neck dissection, race, and gender
Mendenhall (2006) [12]	Base of tongue N = 333	5yr LC: T1 98%; T2 92%; T3 82%; and T4 53% 5yr LRC: stage I-II 100%; III 82%; IVA 87%; and IVB 58%. 5yr OS: stage I-II 67%; III 66%; IVA 67%; IVB 33%.
GORTEC 94-01 (2004) [16]	Oropharynx N = 226	(RT alone) 5-yr LRC 25%; DFS 15%; OS 16% (RT + CT) 5-yr LRC 48%; DFS 27%; OS 22%	OS and LRC: Stage, pretreatment hemoglobin, treatment modality
Present series	Oropharynx N = 627	3yr LC 49%; LRC 41%; DFS 39% and OS 36% DFS Stage I 80%; II 66%; III 46%; IV 25%	LC: KPS, T stage, N stage, Total RT dose and OTT LRC & DFS: Tobacco abuse, KPS, N stage, Total RT dose and OTT.

CT: chemotherapy; DFS: disease free survival; KPS: Karnofsky performance score; LC: local control; LRC: locoregional control; OTT: overall treatment time; RT: radiotherapy.

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