Clinical Profile and Outcome of Viral-Mediated Pharyngeal Carcinoma at a Western Institution
Bibliographic record
Abstract
To compare clinical profile and outcome between viral-mediated oropharyngeal (OPC) and nasopharyngeal carcinoma (NPC) at a western institution. All newly diagnosed nonmetastatic viral-mediated OPC and NPC treated with IMRT from 2005 to 2014 were reviewed. Viral etiology was confirmed by p16 immuno-staining for HPV and EBER in situ hybridization for EBV. Demographics, the 8th edition TNM for HPV+ OPC (ICON-S) and NPC, failure patterns, and outcomes were compared between OPC and NPC. A total of 802 OPC (801 HPV+; 1 EBV+) and 369 NPC (360 EBER+ and 9 HPV+) were viral-mediated. NPC patients were mostly Asian (75% vs 4%) while most OPC were Caucasian (94% vs 20%) (both P < .01). Compared to NPC, OPC patients were older (median 59 vs 52 years, P < .001), predominantly male (83% vs 67%, P<.001), and had more advanced stage (P < .001). Median follow-up was 5.0 years for the entire cohort. Compared to NPC, OPC had similar 5-year overall survival (OS) (80% vs 87%, P = .073), regional control (96% vs 94%, P = .230) and distant control (88% vs 88%, P = .530). Local control was higher in OPC (96% vs 91%, P<.001) and remained significant after adjusting for T/smoking/age (HR = 0.43, P = .004). Late toxicity rates were marginally lower with OPC (19% vs 25%, P = .062). Similar 5-year RFS was found according to the same TNM stage grid: T1-2N0-1 disease (i.e. early disease: stage I OPC; stage I-II NPC) (91% vs 90%, P = .26), T1-2N2 or T3N0-2 disease (intermediate disease: stage II OPC; stage III NPC) (84% vs 87%, P = .95), and T4 or N3 disease (advanced disease: stage III OPC; stage IVA-IVB NPC) (69% vs 63%, P = .56). Distant metastasis (DM) was the main form of failure and occurred in 92 (11%) OPC and 51 (14%) NPC patients. Most DMs (85% OPC and 76% NPC) did not have locoregional failure (P = .22). Multisite involvement was common in those with DM (51% OPC and 35% NPC) and most evident in lung, liver, and bone. Interestingly, DM to brain was more frequent in OPC versus NPC (13% vs 2%, P = .03). OS after DM for OPC and NPC were similar (5-year: 17% vs 22%, P = .20). Of patients with DM, 24 of 92 (26%) OPC and 15 of 51 (29%) NPC survived more than 2 years after DM. This large western cohort study shows that ethnic susceptibility remains after inter-continental migration. Viral type has a distinct anatomic preference. HPV usually causes OPC, but may occasionally cause NPC. The outcome and pattern of failure are very similar by the 8th edition TNM classification. However, local control is slightly lower in NPC, likely reflecting anatomic challenges in NPC. DM is the main form of failure for both NPC and OPC but long-term survivors after DM are seen in the 2 diseases. Such similarities in clinical behavior could reflect common mechanisms of oncogenesis, metastasis, and radio-/chemo-sensitivity and/or resistance induced by HPV and EBV.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".