Study Findings Support Reducing Posttreatment Surveillance Schedule for HPV-Associated OPSCC
Results from a retrospective cohort study suggest that the NCCN-recommended, posttreatment, clinical surveillance schedule for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) should be reduced (JAMA Otolaryngol Head Neck Surg. 2019 Aug 8. Epub ahead of print).
“NCCN…guidelines recommend routine clinical follow-up as posttreatment surveillance for patients with head and neck cancer (HNC),” Farzad Masroor, MD, Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, California, and colleagues explained.
“HPV-associated OPSCC…is a unique subset of HNC, associated with fewer recurrences and improved survival,” they continued.
Citing limited data on the utility of this guideline in this patient population, Dr Masroor et al conducted a study to determine adherence to the NCCN clinical follow-up guideline; frequency of recurrence detection method (ie, symptom-, physician-, or imaging-detected); and survival benefit tied to NCCN guideline adherence.
A total of 233 patients (mean age at diagnosis, 60.5 years) with HPV-associated OPSCC diagnosed between January 1, 2011, and April 30, 2014, were recruited from a large integrated healthcare system. Notably, 201 (86.3%) of the patients in the study were men, 189 (81.1%) were white, and 109 (46.8%) had a positive smoking history.
Dr Masroor and co-investigators used the Cox proportional hazards regression model to carry out multivariable analyses, with patient adherence to NCCN visit guidelines constructed as a time-dependent variable. September 1, 2018 was the cutoff date for all data analyses.
The median follow-up time frame was 4.5 years. In year 1, there were 180 (83.0%) of 217 patients adherent to NCCN surveillance guidelines; in year 2, a total of 106 (52.7%) of 201 patients were adherent; in year 3, there were 141 (73.4%) of 192 patients adherent; year 4 yielded 96 (62.3%) adherent patients out of 154; and in year 5, a total of 45 (52.9%) of 85 patients were adherent to the guidelines.
According to results from 3358 clinical surveillance exams, 22 patients had instances of recurrence; 10 were symptom-directed, 1 was physician-detected, and 11 were imaging-detected.
“Of the symptom-directed recurrences, salvage therapy was attempted in 5; at the study end date, 1 was alive. Salvage neck dissection was attempted in the physician-detected recurrence; this patient subsequently died,” Dr Masroor et al reported. Locoregional recurrences all took place within the first 2 years, whereas all salvageable recurrences occurred within the first year.
Furthermore, NCCN guideline adherence was not found to be protective against all-cause mortality in the multivariable Cox proportional hazards regression model (hazard ratio, 0.76; 95% CI, 0.28-2.05).
“Among patients with HPV-associated OPSCC, clinical surveillance is of limited utility. Nearly all clinically detected recurrences were elicited by patient symptoms that prompted earlier presentation to the clinician,” Dr Masroor and colleagues said.
“Adherence to the current schedule does not appear to confer survival advantage, and locoregional recurrences are almost never detected beyond 2 years. These findings support reduction of posttreatment clinical surveillance in this population,” they concluded.—Hina Porcelli