Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
INTRODUCTION: Head and neck squamous cell carcinoma (HNSCC) is among the most common malignancies worldwide. Primary tumor site and p16 status may have an impact on clinical presentation, while mild symptoms and prior misdiagnosis can lead to a delay in accurate diagnosis and treatment initiation. The aim of this study is to investigate the relationship among p16 status, tumor site, symptom duration, and prior misdiagnosis, as well as identify any prognostic impact these variables might have on patient outcomes.
METHODS: A retrospective chart review was performed for patients diagnosed with HNSCC during a 7-year period at a single tertiary academic center. Demographics, clinical presentation, and patient outcome data was collected and stored in a REDCap database. Chi-square tests were performed to determine association amongst variables, while Univariate Cox Regression and Kaplan-Meier analyses were performed to identify prognosticators.
RESULTS: A total of 437 patients were included in the final analysis. The majority of patients were male (74.1%), and the average age at presentation was 64.3 years ± ??12.4. More than half (60.9%) of patients were smokers, and the mean number of pack-years was 32.9 ± ??22.4. The most frequently reported symptoms were mass (49.9%) and pain (??37.5%), and the most common cancer sites were the oropharynx (40.3%), oral cavity (25.9%) and larynx (13.0%). Of the patients with available p16 data, 52.1% were positive and 47.9% were negative.
Analysis revealed that p16 status did not significantly affect symptom duration or likelihood of misdiagnosis. Symptom duration ≤ 12 months was associated with significantly worse N stage (p=0.049) while symptom duration >12 months correlated with improved overall survival (OR=0.396, p=0.046). Although patients with symptom duration ≤ 6 months also presented with worse N stage (p=0.04), this shorter duration did not impact survival outcomes. On site-dependent analysis, mean symptom duration was similar across head and neck sites, and most of these cancer sites demonstrated no significant association between symptom duration and tumor stage at presentation. The exception to this was cancers of the larynx, in which symptom duration ≤ 12 months may be associated with worse overall tumor stage (p = 0.057) There was also a significantly higher likelihood of misdiagnosis in patients with HNSCC of the paranasal sinuses (p=0.002), nasal cavity (p=0.01), or larynx (p=0.001).
CONCLUSION: Longer duration of symptoms prior to presentation was associated with better overall survival and tumor staging, potentially representing a more indolent cancerous process. Conversely, shorter symptom duration prior to presentation was associated with worse tumor stage and increased mortality, which may be reflective of a more aggressive malignancy with accelerated progression of nodal adenopathy. Although its impact on survival is well-documented in the literature, p16 status was found to have no effect on symptom presentation. Similarly, cancer sites do not influence symptom duration, and the variation among rates of misdiagnosis may be due to nonspecific symptoms. Future studies would be beneficial to further characterize these differences in clinical presentation and patient outcomes.