JAMA Otol Logo Orlando 2013 AHNS Meeting Location
American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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Presentation: S007
Topic: Clinical - Outcomes Research
Type: Oral Presentation
Date: Wednesday, April 10, 2013
Session: 01:30 PM - 02:30 PM Reconstruction / Oropharynx / HPV
Authors: Frank L Palmer, Mr, Nancy Y Lee, Dr, Ian Ganly, Dr, Iain J Nixon, Dr
Institution(s): Memorial Sloan Kettering Cancer Center


Traditional prognostic models for squamous cell carcinoma (SCC) of the head and neck are based on the TNM staging system. However, there is growing evidence that tumor volume (TV) may be a more accurate predictor of outcome. The majority of groups who have investigated the impact of TV used radiological estimates prior to radiation therapy rather than pathologically measured dimensions determined following surgery. The aim of our study was to determine if pathological TV, in patients treated surgically with oropharyngeal SCC, is prognostic of outcome, and how it compares in prognostic value to pathological T stage.

Patients and Methods

159 consecutive patients who had primary surgical resection of oropharyngeal SCC, and had 3 dimensions reported on histopathology within Memorial Sloan Kettering Cancer Center between 1985-2005 were identified. The pathological TV was calculated as the product of the 3 dimensions expressed in cubic centimeters. Disease specific mortality (DSM) local recurrence (LR), regional recurrence (RR) and distant recurrence (DR) were calculated using the Kaplan Meier method for all investigated outcomes except the disease specific death that was estimated by cumulative incidence functions after treating death from causes as competing risks. The relationship between pT stage and outcomes was evaluated using the log rank test or the non-parametric Gray test for disease specific death. The relationship between pTV and outcome was based on the univariable analysis by treating the volume as a continuous predictor with splines to accommodate non-linear relation without categorization. For comparison of pT stage with pTV in outcome prediction, concordance indices were generated using the bootstrap method (n=1000) to quantify the predictive accuracy. Concordance indices were then compared and a significant difference was considered when p<0.05.


The median age was 59 years (range 22-84). There were 106 men (67%) and 53 women (33%). 86 patients had base of tongue (54%), 48 tonsil (30%), 24 soft palate (15%) and 1 posterior pharyngeal wall (1%) tumors. The median follow up was 64 months (range 1-272 months). The median tumor volume was 6.8 cm3 (range 0.045-163 cm3).

The 5 year disease specific mortality (DSM), local recurrence (LR), regional recurrence (RR) and distant recurrence free survival (DR) were 23%, 16%, 13% and 17% respectively.

pT stage, was a significant predictor of 5 year DSM, with pT1 5y DSM of 6%, pT2 12%, pT3 25% and pT4 46%, p<0.001. However, pT stage was not a significant predictor of LR, RR or DR. 


univariate analysis of outcome, tumor volume was a significant predictor of DSM. However, unlike pT, pTV was a significant predictor of LR, RR and DR (Table 1). Comparison of concordance indices showed that pathological TV was a significantly better predictor of DSM, LR and DR (p<0.05) (Figure 1). 


Pathological tumor volume outperforms pT stage in the prediction of outcome following surgical treatment of oropharyngeal cancer.


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