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Objective(s): A subset of laryngeal squamous cell carcinoma (LSCC) patients undergoing larynx preserving treatment ultimately require total laryngectomy (TL) for oncologic or functional reasons. This study aims to identify TL risk factors in these patients. Methods: Retrospective cohort study using Veterans Affairs (VA) database. T1–T4 LSCC cases treated with primary radiotherapy (XRT) or chemoradiotherapy (CRT) were assessed for TL and recurrence. Binary logistic and Cox regression and Kaplan–Meier analyses were implemented. Results: Of 5390 cases, 863 (16.0%) underwent TL. On multivariable analysis, age (adjusted odds ratio: 0.97 [0.96–0.98]; p <.001) and N3 disease (0.42 [0.18–1.00]; p =.050) were associated with reduced risk of TL, whereas current alcohol use (1.22 [1.04–1.43]; p =.015) and >T1 disease (T2, 1.76 [1.44–2.17]; p <.001; T3, 2.06 [1.58–2.68]; p <.001; T4, 1.79 [1.26–2.53]; p =.001) were associated with increased risk of TL. However, N2 (adjusted hazard ratio: 1.30 [1.10–1.55]; p =.003) and N3 (2.02 [1.25–3.26]; p =.004) disease were associated with an increased risk for local recurrence. Compared to XRT, treatment with CRT was associated with reduced risk for local recurrence after adjusting for other factors (0.84 [0.70–0.99]; p =.044). Those who do not receive TL following local recurrence have poorer disease‐specific survival (log‐rank, p <.001). In patients without local recurrence, N2 disease was associated with a fourfold increase in risk of TL (4.24 [1.83–9.82]; p <.001). Conclusion: Advanced nodal stage was associated with reduced rates of salvage TL in the setting of local recurrence, and subsequent worse prognosis after recurrence. Conversely, advanced nodal stage may increase the risk for functional salvage TL in patients without recurrence. Level of Evidence: Level 3. [ABSTRACT FROM AUTHOR]

Objectives: Most transoral robotic surgery (TORS) literature for HPV‐positive oropharyngeal squamous cell carcinoma (HPV‐OPC) derives from high‐volume tertiary‐care centers. This study aims to describe long‐term recurrence and survival outcomes among Veterans Health Administration patients. Materials and Methods: Using the US Veterans Affairs database, we identified patients with HPV‐OPC treated with TORS between January 2010 and December 2016. Patients were stratified in risk categories: low (0–1 metastatic nodes, negative margins), intermediate (close margins, 2–4 metastatic nodes, lymphovascular or perineural invasion, pT3‐pT4 tumor), or high (positive margins, extranodal extension (ENE), and/or ≥5 metastatic nodes). Primary outcomes included overall survival (OS), disease‐specific survival (DSS), and recurrence‐free survival (RFS). Results: The cohort included 161 patients of which 29 (18%) were low‐risk, 45 (28%) intermediate‐risk, and 87 (54%) high‐risk. ENE was present in 41% of node‐positive cases and 24% had positive margins. Median follow‐up was 5.6 years (95% CI, 3.0–9.3). The 5‐year DSS for low, intermediate, and high‐risk groups were: 100%, 90.0% (95% CI, 75.4–96.1%), and 88.7% (95% CI, 78.3–94.2%). Pathologic features associated with poor DSS on univariable analysis included pT3‐T4 tumors (HR 3.81, 95% CI, 1.31–11; p = 0.01), ≥5 metastatic nodes (HR 3.41, 95% CI, 1.20–11; p = 0.02), and ENE (HR 3.53, 95% CI, 1.06–12; p = 0.04). Higher 5‐year cumulative incidences of recurrence were observed in more advanced tumors (pT3‐T4, 33% [95% CI, 14–54%] versus pT1‐T2, 13% [95% CI, 8–19%]; p = 0.01). Conclusions: In this nationwide study, patients with HPV‐OPC treated with TORS followed by adjuvant therapy at Veterans Affairs Medical Centers demonstrated favorable survival outcomes comparable to those reported in high‐volume academic centers and clinical trials. Level of Evidence: 4 Laryngoscope, 134:207–214, 2024 [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the outcomes of a hands‐on simulation‐based course with emphasis on procedural techniques, clinical reasoning, and communication skills developed to improve junior Otolaryngology – Head and Neck Surgery (OHNS) residents' preparedness in managing otolaryngologic emergencies. Methods: Junior OHNS residents and faculty from residency programs in California, Nevada, and Arizona participated in this workshop in 2020 and 2021. The stations featured airway management techniques, ultrasound‐guided needle aspiration, nasoseptal hematoma evacuation, and facial fracture repair using various models and cadavers. Participants completed a pre‐workshop survey, post‐workshop survey, and 2‐month follow‐up survey that assessed resident anxiety and confidence in three OHNS emergency situations across knowledge, manual skills, and teamwork using a 5‐point Likert scale. Results: Pre‐workshop surveys reported the least anxiety and most confidence in teamwork, but the most anxiety and least confidence in technical skills and knowledge related to foreign body retrieval and airway management. Immediately post‐workshop participants reported significant reductions in anxiety and increases in confidence, largest in the manual skills domain, in foreign body retrieval (anxiety: −0.99, confidence: +0.95, p <.01) and airway management stations (anxiety: −0.68, confidence: +1.07, p <.01). Data collected for the epistaxis station showed decreasing confidence and increasing anxiety following the workshop. Conclusion: Our findings demonstrate the effectiveness of a workshop in preparing junior residents in potentially lifesaving otolaryngologic techniques that residents will encounter. Optimizing use of simulation centered training can inform the future of residency education, improving confidence and decreasing anxiety in residents responsible for the safety of patients. Level of Evidence: III. [ABSTRACT FROM AUTHOR]

Background: Understanding biological differences between different racial groups of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) patients, who have differences in terms of incidence, survival, and tumor morphology, can facilitate accurate prognostic biomarkers, which can help develop personalized treatment strategies.Methods: This study evaluated whether there were morphologic differences between HPV-associated tumors from Black and White patients in terms of multinucleation index (MuNI), an image analysis-derived metric that measures density of multinucleated tumor cells within epithelial regions on hematoxylin-eosin images and previously has been prognostic in HPV-associated OPSCC patients. In this study, the authors specifically evaluated whether the same MuNI cutoff that was prognostic of overall survival (OS) and disease-free survival in their previous study, TTR , is valid for Black and White patients, separately. We also evaluated population-specific cutoffs, TB for Blacks and TW for Whites, for risk stratification.Results: MuNI was statistically significantly different between Black (mean, 3.88e-4; median, 3.67e-04) and White patients (mean, 3.36e-04; median, 2.99e-04), with p = .0078. Using TTR , MuNI was prognostic of OS in the entire population with hazard ratio (HR) of 1.71 (p = .002; 95% confidence interval [CI], 1.21-2.43) and in White patients with HR of 1.72 (p = .005; 95% CI, 1.18-2.51). Population-specific cutoff, TW , yielded improved HR of 1.77 (p = .003; 95% CI, 1.21-2.58) for White patients, whereas TB did not improve risk-stratification in Black patients with HR of 0.6 (p = .3; HR, 0.6; 95% CI, 0.2-1.80).Conclusions: Histological difference between White and Black patient tumors in terms of multinucleated tumor cells suggests the need for considering population-specific prognostic biomarkers for personalized risk stratification strategies for HPV-associated OPSCC patients. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To evaluate trends in contemporary positive surgical margin incidence in cT1‐T2 oral cavity squamous cell carcinoma and to evaluate factors associated with surgical margin status. Study Design: Retrospective analysis of large dataset. Methods: Retrospective analysis of the National Cancer Database. Results: Between 2004 and 2016, 39,818 patients with cT1 or cT2 oral cavity squamous cell carcinoma received primary curative‐intent surgery. Positive surgical margins were present in 7.95% of patients, and univariable adjusted probability of positive surgical margins over the study period declined by 1% per year (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98–1.0; P =.049). Multivariable regression revealed the annual rate of positive surgical margins declined significantly (OR, 0.95 per year; 95% CI, 0.92–0.97; P <.001). Factors associated with increased odds of positive surgical margins included cT2 disease, subsite, understaged disease, lymphovascular invasion, tumor grade, and positive lymph nodes. Race and socioeconomic status were not associated with surgical margin status. Treatment at an academic center was associated with increased time to definitive surgery (median 35 days IQR 22–50 vs. median 27 days IQR 14–42; P <.001) and a 20% reduction in positive surgical margin rate (OR, 0.80; 95% CI, 0.71–0.90; P <.001). Treatment at high‐volume centers was less likely to be associated with positive surgical margins (OR, 0.85; 95% CI, 0.74–0.98; P =.02). Conclusion: Surgical subsite, clinical T and N category, presence of lymphovascular invasion, and histologic grade were independent predictors of positive surgical margins. Patients are increasingly being treated at high‐volume and academic centers. Overall, the rate of positive surgical margins in cT1‐T2 oral cavity squamous cell carcinoma is decreasing. Level of Evidence: 4 Laryngoscope, 132:1962–1970, 2022 [ABSTRACT FROM AUTHOR]

Background: The objective is to study the effect of Medicaid expansion on postoperative radiation therapy (PORT) delay in patients with head and neck squamous cell carcinoma (HNSCC). Methods: Patients from the National Cancer Database with HNSCC undergoing curative‐intent surgery in the 2 years before and after Medicaid expansion were analyzed (n = 11 717) using the difference‐in‐differences technique to study the effect on PORT delay. Results: The rate of PORT delay before and after expansion was 66.0% and 66.9%, respectively. Medicaid patients had more frequent PORT delay than privately insured patients (pre‐expansion 77.2% vs. 59.4%, p < 0.001; post‐expansion 76.5% vs. 60.9%, p < 0.001). Medicaid expansion had no effect on PORT delay [hazard ratio 0.95, 95% confidence interval 0.81–1.12]. Supplemental analyses revealed that pathologic stage, number of treating facilities, and comorbidities were among several factors associated with PORT delay in the cohort. Conclusion: PORT delay is unacceptably frequent. Improvement in timely adjuvant therapy requires more than Medicaid expansion. [ABSTRACT FROM AUTHOR]

Background: The oncologic outcomes of surgery alone for patients with American Joint Committee on Cancer 7th edition (AJCC 7th) pN2a and pN2b human papillomavirus–associated oropharynx squamous cell carcinoma (HPV+OPSCC) are not clear. Methods: The authors performed a 12‐institution retrospective study of 344 consecutive patients with HPV+OPSCC (AJCC 7th pT0‐3 N3 M0) treated with surgery alone with 6 months or more of follow‐up using univariate and multivariate analyses. Results: The 2‐year outcomes for the entire cohort were 91% (182 of 200) disease‐free survival (DFS), 100% (200 of 200) disease‐specific survival (DSS), and 98% (200 of 204) overall survival (OS). The 18 recurrences within 2 years were 88.9% (16 of 18) local and/or regional recurrences and 11.1% (2 of 18) distant metastases. Recurrences were not significantly associated with smoking, pT stage, or pN stage. The 16 patients with locoregional recurrences within 2 years all underwent successful salvage treatments (median follow‐up after salvage: 13.1 months), 43.8% (7 of 16) of whom underwent salvage surgery alone for a 2‐year overall salvage radiation need of 4.5% (9 of 200). The 2‐year outcomes for the 59 evaluable patients among the 109 AJCC 7th pT0‐2 N2a‐N2b patients with 1 to 3 pathologic lymph nodes (LNs) were as follows: local recurrence, 3.4% (2 of 59); regional recurrence, 8.4% (5 of 59); distant metastases, 0%; DFS, 88.1% (52 of 59); DSS, 100% (59 of 59); OS, 96.7% (59 of 61); and salvage radiation, 5.1% (3 of 59). Conclusions: With careful selection, surgery alone for AJCC 7th pT0‐T2N0‐N2b HPV+OPSCC with zero to 3 pathologic LNs without perineural invasion, extranodal extension, or positive margins results in high DFS, DSS, OS, and salvage treatment success. Because of the short‐term follow‐up, these data support further investigation of treatment de‐escalation in this population. With careful selection, surgery alone for human papillomavirus–associated oropharynx squamous cell carcinoma, American Joint Committee on Cancer 7th edition pT0‐2, N2a‐N2b with 1 to 3 pathologic lymph nodes without perineural invasion, extranodal extension, or positive margins can result in favorable disease‐free survival, disease‐specific survival, overall survival, and salvage treatment success rates. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Subglottic squamous cell carcinoma (SSCC) is a rare cancer with limited evidence‐based treatment guidelines. This study aimed to describe the treatment patterns for SSCC and to determine which treatments provide the best overall survival. Study Design: Retrospective database review. Methods: The National Cancer Database (NCDB) was queried for patients treated for SSCC from 2004 through 2014. Overall survival (OS) rates were determined by the Kaplan‐Meier method. Clinicopathologic characteristics were assessed by univariable and multivariable Cox proportional hazards models, which corrected for age, sex, race, insurance status, income quartile, residence, Charlson‐Deyo comorbidity score, facility type providing treatment, tumor grade, and clinical N and T category. Results: In this cohort of 549 patients with SSCC, the 5‐year OS was 48.2%. SSCC presented at an advanced stage (American Joint Committee on Cancer stage III or IV) in 60.1% of cases; 78.3% of cases had no nodal metastases. Among only stage IV cases, multivariable analysis showed that radiotherapy (RT) (hazard ratio [HR] = 5.944; 95% confidence interval [CI]: 2.76‐12.8; P <.001) and chemoradiotherapy (CRT) (HR = 2.321; 95% CI: 1.36‐3.97; P =.002) were both associated with decreased 5‐year OS compared to a group consisting of all surgeries. When this analysis was repeated for only stage III cases, RT (HR = 1.134; 95% CI: 0.38‐3.37; P =.821) and CRT (HR = 1.784; 95% CI: 0.78‐4.08; P =.170) were equivalent to surgery. Conclusions: Using the NCDB to study the largest cohort of SSCC with known staging and treatment, primary surgery may provide a better 5‐year OS in advanced‐stage SSCC. Level of Evidence: 4 Laryngoscope, 131:E1117–E1124, 2021 [ABSTRACT FROM AUTHOR]

Objective: To identify the dominant clinical factors associated with increased 1-year charges in treating head and neck cancer.Study Design: Retrospective review.Setting: Single academic institution.Subjects and Methods: We retrospectively reviewed 1-year charges for 196 consecutive patients with head and neck cancer (HNC) who were treated exclusively at our institution. We analyzed charges by department as well as factors associated with increased charges per multivariable regression.Results: The mean age was 59.6 years (SD, 14.9). Most of the population was male (64%), white (70%), and commercially insured (46%). The most common primary sites were the oropharynx (25%; 76%, HPV positive), skin (19%), and thyroid (17%). Eighty-three percent of total charges were due to standard-of-care treatment for HNC: surgery ($16 million), radiation therapy ($22 million), or chemotherapy ($11 million). The median total charge per patient was $212,484 (interquartile range, $78,630-$475,823). Multivariable regression demonstrated that the following were associated with increased charges: nasopharynx subsite ($250,929 [95% CI, $93,290-$408,569]; effect size in US dollars, P = .002), advanced stage (American Joint Committee on Cancer, seventh edition; $80,331 [$22,726-$137,936], P = .007), therapeutic surgery ($281,893 [$117,371-$446,415], P = .001), chemotherapy ($183,331 [$125,497-$241,165], P < .001), radiation ($203,397 [$143,454-$263,341], P < .001), surgical complication requiring return to the operating room ($147,247 [$37,240-$257,254], P = .009), emergency department visits ($89,050 [$23,811-$154,289], P = .008), and admissions ($140,894 [$82,895-$198,893], P < .001; constant, -$233,927 [-$410,790 to -$57,064]). The top quartile accrued 55% of the total charges.Conclusion: Radiation, followed by surgery and chemotherapy, were the most expensive components of HNC care. In this analysis, we identified the dominant clinical factors associated with increased charges. [ABSTRACT FROM AUTHOR]

Background: Recurrent head and neck squamous cell carcinoma (HNSCC) after radiation is associated with poor survival, and management of the clinically negative (N0) neck during salvage surgery is controversial. Methods: Studies were selected according to preferred reporting items for systematic reviews and meta‐analyses guidelines. Inclusion criteria were patients with HNSCC, prior radiation to the lateral neck nodal basin, undergoing salvage surgery for local recurrence, persistence or second primary, and N0 at time of salvage. Eleven studies with a total of 382 patients met inclusion criteria. Results: The rate of occult metastasis was 15.4%. The pooled rate of occult nodal metastasis was 16.2% for oral cavity, 12.9% for oropharynx, 23.7% for hypopharynx, and 27.3% for supraglottic or transglottic tumors. There was a significantly higher relative risk of occult metastasis for locally advanced tumors. Conclusion: Elective neck dissection at time of salvage surgery should be considered based on subsite, T classification, and prior history of nodal metastasis. [ABSTRACT FROM AUTHOR]

Background: Rapid spread of the severe acute respiratory syndrome‐coronavirus‐2 (SARS‐CoV‐2) virus has left many health systems around the world overwhelmed, forcing triaging of scarce medical resources. Identifying indicators of hospital admission for coronavirus disease 2019 (COVID‐19) patients early in the disease course could aid the efficient allocation of medical interventions. Self‐reported olfactory impairment has recently been recognized as a hallmark of COVID‐19 and may be an important predictor of clinical outcome. Methods: A retrospective review of all patients presenting to a San Diego Hospital system with laboratory‐confirmed positive COVID‐19 infection was conducted with evaluation of olfactory and gustatory function and clinical disease course. Univariable and multivariable logistic regression were performed to identify risk factors for hospital admission and anosmia. Results: A total of 169 patients tested positive for COVID‐19 disease between March 3 and April 8, 2020. Olfactory and gustatory data were obtained for 128 (75.7%) of 169 subjects, of which 26 (20.1%) of 128 required hospitalization. Admission for COVID‐19 was associated with intact sense of smell and taste, increased age, diabetes, and subjective and objective parameters associated with respiratory failure. On adjusted analysis, anosmia was strongly and independently associated with outpatient care (adjusted odds ratio [aOR] 0.09; 95% CI, 0.01‐0.74), whereas positive findings of pulmonary infiltrates and/or pleural effusion on chest radiograph (aOR 8.01; 95% CI, 1.12‐57.49) was strongly and independently associated with admission. Conclusion: Normosmia is an independent predictor of admission in COVID‐19 cases. Smell loss in COVID‐19 may be associated with a milder clinical course. [ABSTRACT FROM AUTHOR]

Background: Rapid spread of the severe acute respiratory syndrome‐coronavirus‐2 (SARS‐CoV‐2) and concern for viral transmission by ambulatory patients with minimal to no symptoms underline the importance of identifying early or subclinical symptoms of coronavirus disease 2019 (COVID‐19) infection. Two such candidate symptoms include anecdotally reported loss of smell and taste. Understanding the timing and association of smell/taste loss in COVID‐19 may help facilitate screening and early isolation of cases. Methods: A single‐institution, cross‐sectional study evaluating patient‐reported symptoms with a focus on smell and taste was conducted using an internet‐based platform on adult subjects who underwent testing for COVID‐19. Logistic regression was employed to identify symptoms associated with COVID‐19 positivity. Results: A total of 1480 patients with influenza‐like symptoms underwent COVID‐19 testing between March 3, 2020, and March 29, 2020. Our study captured 59 of 102 (58%) COVID‐19–positive patients and 203 of 1378 (15%) COVID‐19–negative patients. Smell and taste loss were reported in 68% (40/59) and 71% (42/59) of COVID‐19–positive subjects, respectively, compared to 16% (33/203) and 17% (35/203) of COVID‐19–negative patients (p < 0.001). Smell and taste impairment were independently and strongly associated with COVID‐19 positivity (anosmia: adjusted odds ratio [aOR] 10.9; 95% CI, 5.08‐23.5; ageusia: aOR 10.2; 95% CI, 4.74‐22.1), whereas sore throat was associated with COVID‐19 negativity (aOR 0.23; 95% CI, 0.11‐0.50). Of patients who reported COVID‐19–associated loss of smell, 74% (28/38) reported resolution of anosmia with clinical resolution of illness. Conclusion: In ambulatory individuals with influenza‐like symptoms, chemosensory dysfunction was strongly associated with COVID‐19 infection and should be considered when screening symptoms. Most will recover chemosensory function within weeks, paralleling resolution of other disease‐related symptoms. [ABSTRACT FROM AUTHOR]

Objective: The use of standing electronic scooters associated with micromobility applications (e‐scooters) has risen nationally. The aim of this study was to obtain a detailed view of soft tissue and bony craniofacial injury associated with e‐scooter‐related trauma. Methods: Single‐institution retrospective case series of patients presenting to a level 1 trauma center emergency department or trauma unit with documented e‐scooter‐related craniofacial injury. Results: Of 203 included patients, 188 (92.6%) patients sustained craniofacial injury. One hundred thirty‐one (64.5%) had exclusively soft tissue injury, 3 (1.5%) exclusively bony injury, 51 (25.1%) both soft and bony injuries, and twenty‐five (12.3%) patients sustained dental injury. Aesthetic units most frequently sustaining acute soft tissue injury were the forehead (n = 106, 34.6%), scalp (n = 36, 11.8%), chin (n = 34, 11.1%), upper lip (n = 32, 10.5%), and cheek (n = 31, 10.1%). Aesthetic subunits most often sustaining acute soft tissue injury included the brow (42, 13.7%), central forehead (39, 12.7%), lateral forehead (n = 25, 8.2%), and upper lip vermillion (n = 23, 7.5%). Craniofacial osseous fracture most often occurred in the orbit (n = 42, 24.6%) and maxilla (n = 40, 23.4%). Individual osseous segments most frequently sustaining acute fracture included the anterior maxillary sinus wall (n = 22, 12.9%), nasal bone (n = 20, 11.7%), lateral orbital wall (n = 16, 9.4%), orbital floor (n = 15, 8.8%), and zygomatic bone (13, 7.6%). Conclusions: Our analysis demonstrates that most patients presenting to our center with craniofacial trauma sustained acute bony fracture, most often to the midface. Our data of common injuries associated with e‐scooter trauma could inform implementation in the form of facial safety equipment or safety skills training for e‐scooter riders. Level of evidence: 4 [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the performance characteristics of seven predetermined imaging features on pretreatment computed tomography (CT) in identifying extranodal extension (ENE) in cervical lymph node metastases from human papillomavirus-positive oropharyngeal carcinoma (HPV-OPC).Study Design: Retrospective study.Methods: Seventy-three patients with HPV-OPC who underwent primary surgery and cervical lymph node dissection were included. Preoperative contrast-enhanced CT (cCT) imaging was evaluated by two radiologists blinded to pathological results. Each cCT was scored for seven imaging features of interest: 1) indistinct capsular contours, 2) irregular nodal margins, 3) perinodal fat stranding, 4) perinodal fat planes, 5) nodal necrosis, 6) intranodal cysts, and 7) nodal matting. Logistic regression was employed to determine radiologist-specific odds ratios (OR) of predicting ENE for each imaging feature and radiologist-specific receiver operating characteristics (sensitivity [Sn], specificity [Sp], area under the curve [AUC], positive predictive value [PPV], negative predictive value [NPV]) for each imaging feature.Results: Thirty-two (44%) patients had ENE-positive lymph nodes. The presence of irregular margins (ORA = 12.3, 95% confidence interval [CI]A = 2.3-65.9; ORB = 7.0, 95% CIB = 1.4-36.3) and absence of perinodal fat plane (ORA = 6.8, 95% CIA = 2.0-23.3; ORB = 14.2, 95% CIB = 1.7-120.5) were significantly associated with ENE for each radiologist. Irregular nodal margin status was most specific for ENE (SnA = 45%, SpA = 94%, AUCA = 69%, PPVA = 82%, NPVA = 73%; SnB = 28%, SpB = 95%, AUCB = 61%, PPVB = 80%, NPVB = 64%). Absence of perinodal fat plane was most sensitive for ENE (SnA = 87%, SpA = 50%, AUCA = 69%, PPVA = 59%, NPVA = 62%; SnB = 96%, SpB = 34%, AUCB = 65%, PPVB = 53%, NPVB = 63%).Conclusions: Of the seven imaging features hypothesized to be associated with ENE-status, the presence of irregular nodal margins and absence of perinodal fat plane were the most specific and sensitive features, respectively.Level Of Evidence: 4 Laryngoscope, 130:1479-1486, 2020. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To evaluate if a simple method for assessing tumor-infiltrating lymphocytes (TIL) in primary tumor specimens improves the prognostic value of the American Joint Committee on Cancer, 8th Edition (AJCC8) cancer staging system in human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV-OPC).Study Design: Retrospective study.Methods: In this study, TIL density was quantified on hematoxylin and eosin (H&E)-stained specimens from patients presenting to Johns Hopkins Hospital between 2009 and 2017 who underwent primary surgical therapy and had primary tumor specimens available for analysis. The prognostic effect of TIL density was evaluated by Kaplan-Meier method and Cox proportional hazards models considering recurrence-free survival (RFS) as the primary outcome.Results: This study included 132 patients. Ninety-five percent were classified by clinical criteria with AJCC8 early-stage disease (stage I: 82%, stage II: 13%). After 84 months of follow-up, 15 recurrences were observed. Among clinically early-stage disease, TILhigh status was associated with improved RFS compared to TILlow (P = .002). Adjusted analysis showed TILhigh status was associated with 79% lower risk of recurrence than TILlow (adjusted hazard ratio [aHR]: 0.210, 95% confidence interval [CI]: 0.061-0.723). In clinical stage I disease, TILhigh status was associated with improved RFS compared to TILlow in both univariate and multivariate analyses (hazard ratio: 0.235, P = .021; aHR: 0.218; 95% CI: 0.058-0.822). TIL density similarly stratified risk in pathologically staged disease.Conclusions: In patients with AJCC8 stage I disease, low TIL density was associated with diminished RFS. Our data suggest that assessing TIL density on H&E-stained primary tumor specimens may enhance the prognostic resolution of the AJCC8 staging criteria for HPV-OPC.Level Of Evidence: 4 Laryngoscope, 130:930-938, 2020. [ABSTRACT FROM AUTHOR]

Objective: Basaloid squamous cell histology is a rare variant that accounts for about 2% of all head and neck squamous cell laryngeal carcinomas. The purpose of this study was to examine overall survival rates of patients according to treatment, stage, and laryngeal subsite.Study Design: Retrospective analysis.Setting: National Cancer Database (NCDB).Subjects and Methods: The NCDB was queried for patients with basaloid squamous cell carcinoma (BSCC) who were treated from 2004 to 2014. Five-year overall survival rates were determined by the Kaplan-Meier method. Univariate and multivariate analysis was used to identify factors correlated with 5-year overall survival.Results: The NCDB identified 440 patients meeting inclusion criteria. Median follow-up time was 31.2 months. On univariate analysis, the treatment modalities assessed (surgery alone, surgery with radiotherapy, surgery with chemoradiotherapy, radiotherapy, chemoradiotherapy) did not differ in their survival benefit. On multivariate analysis, only chemoradiotherapy (hazard ratio, 0.587; 95% CI, 0.37-0.93; P = .022) was associated with improved survival. All treatment modalities performed similarly between stage I and II tumors ( P = .340) and stage III and IV tumors ( P = .154).Conclusion: This study represents the largest laryngeal BSCC series to date. We found that chemoradiotherapy was associated with improved 5-year overall survival of laryngeal BSCC on multivariate analysis. [ABSTRACT FROM AUTHOR]

Background: In the era of deintensification, little data are available regarding patients' treatment preferences. The current study evaluated treatment‐related priorities, concerns, and regret among patients with head and neck squamous cell cancer (HNSCC). Methods: A total of 150 patients with HNSCC ranked the importance of 10 nononcologic treatment goals relative to the oncologic goals of cure and survival. The level of concern regarding 11 issues and decision regret was recorded. Median rank was reported overall, and factors associated with odds of rank as a top 3 priority were modeled using logistic regression. Results: Among the treatment effects analyzed, the odds of being a top 3 priority was especially high for cure (odds, 9.17; 95% confidence interval [95% CI], 5.05‐16.63), followed by survival and swallow (odds, 1.26 [95% CI, 0.88‐1.80] and odds, 0.85 [95% CI, 0.59‐1.21], respectively). Prioritization of cure, survival, and swallow was similar based on human papillomavirus (HPV) tumor status. By increasing decade of age, older participants were found to be significantly less likely than younger individuals to prioritize survival (odds ratio, 0.72; 95% CI, 0.52‐1.00). Concerns regarding mortality (P = .04) and transmission of HPV to the patient's spouse (P = .03) were more frequent among participants with HPV‐associated HNSCC. Regret increased with additional treatment modalities (P = .02). Conclusions: Patients with HNSCC overwhelming prioritize cure, followed by survival and swallow. The decreased prioritization of survival by older age supports further examination of treatment preference by age. The precedence of oncologic over nononcologic priorities among patients regardless of HPV tumor status supports the conservative adoption of deintensification regimens until the interplay between competing oncologic and nononcologic treatment goals is better understood. When asked to rank treatment‐related priorities, patients with head and neck squamous cell cancer overwhelmingly prioritize cure, followed by survival and swallow. The results appear to be similar by human papillomavirus tumor status, supporting the conservative adoption of deintensification regimens until the interplay between competing oncologic and nononcologic treatment goals is better understood. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the influence of sex and race/ethnicity upon prevalence trends of human papillomavirus (HPV) in oropharyngeal cancer (OPC) and survival after OPC.Method: This was a cohort study of patients included in the United States National Cancer Database who had been diagnosed with OPC between 2010 and 2015. Outcomes were HPV status of tumor specimens and overall survival. Sex- and race-stratified trends in HPV prevalence were estimated using generalized linear modeling. The influence of sex, race, and HPV tumor status on overall survival was compared by Kaplan-Meier method and Cox Proportional Hazards models.Results: This analysis included 20,886 HPV-positive and 10,364 HPV-negative OPC patients. The prevalence of HPV-positive tumors was higher among men (70.6%) than women (56.3%) and increased significantly over time at a rate of 3.5% and 3.2% per year among men and women, respectively. The prevalence of HPV-positive tumors was highest among whites (70.2%), followed by Hispanics (61.3%), Asians (55.8%), and blacks (46.3%). Blacks and Hispanics experienced significantly more rapid increases in prevalence of HPV-positive tumors over time compared with whites (6.5% vs 5.6% vs 3.2% per year, respectively). In HPV-positive OPC, neither sex nor race/ethnicity was associated with survival among patients with HPV-positive OPC. In contrast, for HPV-negative OPC, risk of death was significantly higher for women versus men (adjusted hazard ratio [aHR], 1.17; 95% confidence interval [CI], 1.08-1.26) and blacks versus whites (aHR, 1.21; 95% CI, 1.10-1.33).Conclusion: The prevalence of HPV-positive tumors is increasing for all sex and race/ethnicity groups in the United States. Sex and race are independently associated with survival for HPV-negative but not HPV-positive OPC. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To review recent literature on human papillomavirus-related (HPV-positive) oropharyngeal squamous cell carcinoma (OPC) and focus on implications of recurrent and metastatic disease. Methods Primary articles from 1990 to 2016 indexed in MEDLINE (1) pertaining to the epidemiology of HPV-positive OPC and (2) providing clinical insight into recurrent and metastatic OPC. Results The incidence of HPV-positive OPC is increasing globally. HPV-positive OPC is a subtype with distinct molecular and clinical features including enhanced treatment response and improved overall survival. While disease recurrence is less common in patients with HPV-positive OPC, up to 36% of patients experience treatment failure within eight years. Recurrent and metastatic OPC has historically signified poor prognosis, however recent data are challenging this dogma. Here, we discuss recurrent and metastatic OPC in the context of HPV tumor status. Conclusion HPV-positive OPC exhibits distinct genetic, cellular, epidemiological, and clinical features from HPV-negative OPC. HPV tumor status is emerging as a marker indicative of improved prognosis after disease progression in both locoregionally recurrent and distant metastatic OPC. Level of Evidence N/A. [ABSTRACT FROM AUTHOR]