Predictive factors of distant metastasis in surgically treated HPV-positive tonsil cancer

Abstract

Background Human papilloma virus (HPV)-related tonsil cancer is associated with favorable outcomes. Objective The purpose of this study was to define factors affecting distant metastasis in patients with surgically treated HPV-positive tonsil cancer. Methods The present study enrolled 76 patients diagnosed with HPV-positive tonsil cancer who underwent primary surgery between January 2010 and December 2021. Results Twelve (15.7%) patients experienced a distant failure with a median follow-up time of 43 months. Sites of distant metastasis included the lung (n = 10), liver (n = 1), and brain (n = 1). Upon multivariate analysis, an advanced T stage (odds ratio [OR]: 13.94, 95% confidence interval [CI]: 1.29–149.863, p = 0.003) and margin involvement (OR: 5.96, 95% CI: 1.33–26.76, p = 0.02) were independent predictors of distant metastases. The five-year disease-specific survival for the entire cohort was 85%. The multivariate analysis confirmed that distant metastasis (hazard ratio [HR]: 12.688, 95% CI: 3.424–47.016; p < 0.001) and margin involvement (HR: 6.243; 95% CI: 1.681–23.191; p = 0.006) were significant factors associated with the five-year disease-specific survival. Conclusion HPV-positive tonsil cancer patients with an advanced T stage and a positive surgical margin have a substantial risk of distant metastases. Distant metastasis and margin involvement are factors that affect their survival.