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Oropharyngeal Squamous Cell Carcinoma in 390 Patients: Analysis of Clinical and Histological Criteria Which Significantly Impact Outcome

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Abstract

This study evaluates the prognostic impact of several factors in oropharyngeal squamous cell carcinoma (OPSCC), controlling for human papillomavirus (HPV)-associated tumors and stage (American Joint Committee on Cancer 8th edition). All patients in Southern California Permanente Medical Group diagnosed with OPSCC between 2006 and 2012 tested for p16 immunohistochemistry were included. Review of all pathology materials was combined with central p16 testing. Multivariable analyses were performed. The cohort of 390 patients included 342 p16-positive and 48 p16-negative tumors. For all-comers, on univariate analysis, the following factors, when present, were associated with improved patient survival: p16-positive tumor (n = 324, p < 0.001); crypt versus surface tumor location (n = 312, p = 0.004); nonkeratinizing type (n = 309, p < 0.0001); nonkeratinizing with maturation type (n = 37, p < 0.0001); basaloid pattern (n = 284, p = 0.005); and a broad, pushing border of infiltration (n = 282, p = 0.004). Inferior survival outcomes were observed with: age ≥ 55 years (p < 0.0001); ≥ 10 pack-year smoking history (n = 183, p = 0.003); increasing tumor stage (p < 0.0001); overt radiographic extranodal extension (ORENE) (n = 58, p < 0.0001); low level IV/Vb lymph node involvement (n = 45, p = 0.0002); a jagged pattern of infiltration (n = 76, p = 0.0004); tumor ulceration (n = 76, p = 0.0004); absent lymphocytic infiltrate (p < 0.0001); and concurrent dysplasia (n = 125, p = 0.009). On multivariable analysis, accounting for patient age, smoking history ≥ 10 pack-years, and TNM stage, for patients with p16-positive disease, advanced TNM stage (p = 0.007), the presence of ORENE (p = 0.0002), and low-neck lymphadenopathy (p = 0.0001) were independent negative prognostic factors for disease free survival (DFS). Older age (p < 0.0001), smoking history ≥ 10 pack-years (p = 0.02), advanced TNM stage (p = 0.0002), ORENE (p = 0.004), and low-neck lymphadenopathy (p = 0.002) were independent negative prognostic factors for OS. Among patients with p16-positive OPSCC, older age, smoking history, advanced stage, ORENE, and low-neck lymphadenopathy were significant negative prognostic factors for DFS and/or OS. Further refinement of staging to incorporate additional lymph node findings may be warranted.

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References

  1. Gillison ML, Koch WM, Capone RB, et al. Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. J Natl Cancer Inst. 2000;92:709–20.

    CAS  Google Scholar 

  2. Fakhry C, Westra WH, Li S, et al. Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst. 2008;100:261–9.

    CAS  Google Scholar 

  3. Gillison ML, D’Souza G, Westra W, et al. Distinct risk factor profiles for human papillomavirus type 16-positive and human papillomavirus type 16-negative head and neck cancers. J Natl Cancer Inst. 2008;100:407–20.

    Google Scholar 

  4. Ang KK, Harris J, Wheeler R, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010;363:24–35.

    CAS  Google Scholar 

  5. Skillington SA, Kallogjeri D, Lewis JS Jr, Piccirillo JF. Prognostic importance of comorbidity and the association between comorbidity and p16 in oropharyngeal squamous cell carcinoma. JAMA Otolaryngol Head Neck Surg. 2016;142:568–75.

    Google Scholar 

  6. Sinha P, Thorstad WT, Nussenbaum B, et al. Distant metastasis in p16-positive oropharyngeal squamous cell carcinoma: a critical analysis of patterns and outcomes. Oral Oncol. 2014;50:45–51.

    CAS  Google Scholar 

  7. Chernock RD, Lewis JS Jr, Zhang Q, El-Mofty SK. Human papillomavirus-positive basaloid squamous cell carcinomas of the upper aerodigestive tract: a distinct clinicopathologic and molecular subtype of basaloid squamous cell carcinoma. Hum Pathol. 2010;41:1016–23.

    CAS  Google Scholar 

  8. Carpenter DH, El-Mofty SK, Lewis JS Jr. Undifferentiated carcinoma of the oropharynx: a human papillomavirus-associated tumor with a favorable prognosis. Mod Pathol. 2011;24:1306–12.

    CAS  Google Scholar 

  9. Cai C, Chernock RD, Pittman ME, El-Mofty SK, Thorstad WL, Lewis JS Jr. Keratinizing-type squamous cell carcinoma of the oropharynx: p16 overexpression is associated with positive high-risk HPV status and improved survival. Am J Surg Pathol. 2014;38:809–15.

    Google Scholar 

  10. Allen CT, Lewis JS Jr, El-Mofty SK, Haughey BH, Nussenbaum B. Human papillomavirus and oropharynx cancer: biology, detection and clinical implications. Laryngoscope. 2010;120:1756–72.

    Google Scholar 

  11. Chernock RD, El-Mofty SK, Thorstad WL, Parvin CA, Lewis JS Jr. HPV-related nonkeratinizing squamous cell carcinoma of the oropharynx: utility of microscopic features in predicting patient outcome. Head Neck Pathol. 2009;3:186–94.

    Google Scholar 

  12. Begum S, Gillison ML, Ansari-Lari MA, Shah K, Westra WH. Detection of human papillomavirus in cervical lymph nodes: a highly effective strategy for localizing site of tumor origin. Clin Cancer Res. 2003;9:6469–75.

    CAS  Google Scholar 

  13. Fossum CC, Chintakuntlawar AV, Price DL, Garcia JJ. Characterization of the oropharynx: anatomy, histology, immunology, squamous cell carcinoma and surgical resection. Histopathology. 2017;70:1021–9.

    Google Scholar 

  14. Bhattasali O, Han J, Thompson LDR, Buchschacher GL Jr, Abdalla IA, Iganej S. Induction chemotherapy followed by concurrent chemoradiation versus concurrent chemoradiation alone in the definitive management of p16-positive oropharyngeal squamous cell carcinoma with low-neck or N3 disease. Oral Oncol. 2018;78:151–5.

    Google Scholar 

  15. Onita B, Lester DRT, Iman AA, Jergin C, Shawn I. Comparison of high-dose Cisplatin-based chemoradiotherapy and Cetuximab-based bioradiotherapy for p16-positive oropharyngeal squamous cell carcinoma in the context of revised HPV-based staging. Rep Pract Oncol Radiother. 2018;23:451–7.

    Google Scholar 

  16. Iganej S, Beard BW, Chen J, et al. Triweekly carboplatin as a potential de-intensification agent in concurrent chemoradiation for early-stage HPV-associated oropharyngeal cancer. Oral Oncol. 2019;97:18–22.

    CAS  Google Scholar 

  17. Bhattasali O, Ryoo JJ, Thompson LDR, Abdalla IA, Chen J, Iganej S. Impact of chemotherapy regimen on treatment outcomes in patients with HPV-associated oropharyngeal cancer with T4 disease treated with definitive concurrent chemoradiation. Oral Oncol. 2019;95:74–8.

    CAS  Google Scholar 

  18. Amin MB, Edge SB, Greene FL, Byrd DR, Brookland RK. AJCC cancer staging manual. Chicago: Springer; 2017.

    Google Scholar 

  19. Lewis JS Jr, Khan RA, Masand RP, et al. Recognition of nonkeratinizing morphology in oropharyngeal squamous cell carcinoma—a prospective cohort and interobserver variability study. Histopathology. 2012;60:427–36.

    Google Scholar 

  20. Lewis JS Jr, Beadle B, Bishop JA, et al. Human papillomavirus testing in head and neck carcinomas: guideline from the college of american pathologists. Arch Pathol Lab Med. 2018;142:559–97.

    Google Scholar 

  21. Lassen P, Lacas B, Pignon JP, et al. Prognostic impact of HPV-associated p16-expression and smoking status on outcomes following radiotherapy for oropharyngeal cancer: the MARCH-HPV project. Radiother Oncol. 2018;126:107–15.

    CAS  Google Scholar 

  22. Haigentz M Jr, Suarez C, Strojan P, et al. Understanding interactions of smoking on prognosis of HPV-associated oropharyngeal cancers. Adv Ther. 2018;35:255–60.

    Google Scholar 

  23. Hashibe M, Brennan P, Benhamou S, et al. Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. J Natl Cancer Inst. 2007;99:777–89.

    Google Scholar 

  24. Gillison ML, Zhang Q, Jordan R, et al. Tobacco smoking and increased risk of death and progression for patients with p16-positive and p16-negative oropharyngeal cancer. J Clin Oncol. 2012;30:2102–11.

    CAS  Google Scholar 

  25. Wain SL, Kier R, Vollmer RT, Bossen EH. Basaloid-squamous carcinoma of the tongue, hypopharynx, and larynx: report of 10 cases. Hum Pathol. 1986;17:1158–66.

    CAS  Google Scholar 

  26. Wieneke JA, Thompson LD, Wenig BM. Basaloid squamous cell carcinoma of the sinonasal tract. Cancer. 1999;85:841–54.

    CAS  Google Scholar 

  27. Thompson LDR, Wenig BM, Heffner DK, Gnepp DR. Exophytic and papillary squamous cell carcinomas of the larynx: A clinicopathologic series of 104 cases. Otolaryngol Head Neck Surg. 1999;120:718–24.

    CAS  Google Scholar 

  28. Gondim DD, Haynes W, Wang X, Chernock RD, El-Mofty SK, Lewis JS Jr. Histologic ty** in oropharyngeal squamous cell carcinoma: a 4-year prospective practice study with p16 and high-risk HPV mRNA testing correlation. Am J Surg Pathol. 2016;40:1117–24.

    Google Scholar 

  29. Yamashita Y, Ikegami T, Hirakawa H, et al. Staging and prognosis of oropharyngeal carcinoma according to the 8th Edition of the American Joint Committee on Cancer Staging Manual in human papillomavirus infection. Eur Arch Otorhinolaryngol. 2019;276:827–36.

    Google Scholar 

  30. Sinha P, Haughey BH, Kallogjeri D, Jackson RS. Long-term analysis of transorally resected p16 + oropharynx cancer: outcomes and prognostic factors. Laryngoscope. 2019;129:1141–9.

    CAS  Google Scholar 

  31. Jouhi L, Halme E, Irjala H, et al. Epidemiological and treatment-related factors contribute to improved outcome of oropharyngeal squamous cell carcinoma in Finland. Acta Oncol. 2018;57:541–51.

    Google Scholar 

  32. Munscher A, Bussmann L, Sehner S, et al. Survival analysis of 287 oropharyngeal squamous cell carcinoma patients in a single institution: a retrospective comparison of two consecutive time intervals with surgical and conservative treatment approaches. Eur Arch Otorhinolaryngol. 2017;274:3211–9.

    Google Scholar 

  33. Ryu HJ, Kim EK, Heo SJ, Cho BC, Kim HR, Yoon SO. Architectural patterns of p16 immunohistochemical expression associated with cancer immunity and prognosis of head and neck squamous cell carcinoma. Apmis. 2017;125:974–84.

    CAS  Google Scholar 

  34. D’Souza G, Westra WH, Wang SJ, et al. Differences in the prevalence of human papillomavirus (HPV) in head and neck squamous cell cancers by sex, race, anatomic tumor site, and HPV detection method. JAMA Oncol. 2017;3:169–77.

    Google Scholar 

  35. Channir HI, Kiss K, Rubek N, et al. Comparison of clinical, radiological and morphological features including the distribution of HPV E6/E7 oncogenes in resection specimens of oropharyngeal squamous cell carcinoma. Oral Oncol. 2018;78:163–70.

    Google Scholar 

  36. Carpen T, Sjoblom A, Lundberg M, et al. Presenting symptoms and clinical findings in HPV-positive and HPV-negative oropharyngeal cancer patients. Acta Otolaryngol. 2018;138:513–8.

    Google Scholar 

  37. Yin LX, D’Souza G, Westra WH, et al. Prognostic factors for human papillomavirus-positive and negative oropharyngeal carcinomas. Laryngoscope. 2018;128:E287-e95.

    Google Scholar 

  38. Wang F, Zhang H, Xue Y, et al. A systematic investigation of the association between HPV and the clinicopathological parameters and prognosis of oral and oropharyngeal squamous cell carcinomas. Cancer Med. 2017;6:910–7.

    CAS  Google Scholar 

  39. Dave E, Su W, Gupta V, et al. Human papilloma virus-positive oropharyngeal squamous cell carcinoma in the elderly. Anticancer Res. 2017;37:1847–51.

    Google Scholar 

  40. Wagner S, Wittekindt C, Sharma SJ, et al. Human papillomavirus association is the most important predictor for surgically treated patients with oropharyngeal cancer. Br J Cancer. 2017;116:1604–11.

    Google Scholar 

  41. Fakhry C, Westra WH, Wang SJ, et al. The prognostic role of sex, race, and human papillomavirus in oropharyngeal and nonoropharyngeal head and neck squamous cell cancer. Cancer. 2017;123:1566–75.

    CAS  Google Scholar 

  42. Beltz A, Gosswein D, Zimmer S, et al. Staging of oropharyngeal squamous cell carcinoma of the head and neck: Prognostic features and power of the 8th edition of the UICC staging manual. Eur J Surg Oncol. 2019;45:1046–53.

    Google Scholar 

  43. Martinez RC, Sathasivam HP, Cosway B, et al. Clinicopathological features of squamous cell carcinoma of the oral cavity and oropharynx in young patients. Br J Oral Maxillofac Surg. 2018;56:332–7.

    Google Scholar 

  44. D’Souza G, Kreimer AR, Viscidi R, et al. Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med. 2007;356:1944–56.

    Google Scholar 

  45. Singhi AD, Westra WH. Comparison of human papillomavirus in situ hybridization and p16 immunohistochemistry in the detection of human papillomavirus-associated head and neck cancer based on a prospective clinical experience. Cancer. 2010;116:2166–73.

    Google Scholar 

  46. Rettig EM, Fakhry C, Khararjian A, Westra WH. Age profile of patients with oropharyngeal squamous cell carcinoma. JAMA Otolaryngol Head Neck Surg. 2018;144:538–9.

    Google Scholar 

  47. Mhawej R, Ghorra C, Naderi S, Khoueir N, Abou Hamad W, Melkane AE. Human papillomavirus prevalence and clinicopathological associations in oropharyngeal squamous cell carcinoma in the Lebanese population. J Laryngol Otol. 2018;132:636–41.

    CAS  Google Scholar 

  48. Rasmussen JH, Gronhoj C, Hakansson K, et al. Risk profiling based on p16 and HPV DNA more accurately predicts location of disease relapse in patients with oropharyngeal squamous cell carcinoma. Ann Oncol. 2019;30:629–36.

    CAS  Google Scholar 

  49. Bauer E, Mazul A, Chernock R, et al. Extranodal extension is a strong prognosticator in HPV-positive oropharyngeal squamous cell carcinoma. Laryngoscope. 2019. https://doi.org/10.1002/lary.28059.

    Article  Google Scholar 

  50. Park YM, Kang MS, Koh YW, Choi EC, Kim SH. Does p16+predict a favorable prognosis for oropharyngeal cancer? Risk factors for treatment failure for patients who underwent surgery-based therapy. Ann Surg Oncol. 2019;26:547–54.

    Google Scholar 

  51. Spector ME, Chinn SB, Bellile E, et al. Matted nodes as a predictor of distant metastasis in advanced-stage III/IV oropharyngeal squamous cell carcinoma. Head Neck. 2016;38:184–90.

    Google Scholar 

  52. Vainshtein JM, Spector ME, Ibrahim M, et al. Matted nodes: high distant-metastasis risk and a potential indication for intensification of systemic therapy in human papillomavirus-related oropharyngeal cancer. Head Neck. 2016;38(Suppl 1):E805–14.

    Google Scholar 

  53. Liu JT, Kann BH, De B, et al. Prognostic value of radiographic extracapsular extension in locally advanced head and neck squamous cell cancers. Oral Oncol. 2016;52:52–7.

    CAS  Google Scholar 

  54. Kann BH, Buckstein M, Carpenter TJ, et al. Radiographic extracapsular extension and treatment outcomes in locally advanced oropharyngeal carcinoma. Head Neck. 2014;36:1689–94.

    Google Scholar 

  55. Sanguineti G, Pai S, Agbahiwe H, et al. HPV-related oropharyngeal carcinoma with Overt Level II and/or III metastases at presentation: the risk of subclinical disease in ipsilateral levels IB, IV and V. Acta Oncol. 2014;53:662–8.

    CAS  Google Scholar 

  56. O’Sullivan B, Huang SH, Su J, et al. Development and validation of a staging system for HPV-related oropharyngeal cancer by the International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S): a multicentre cohort study. Lancet Oncol. 2016;17:440–51.

    Google Scholar 

  57. Tian S, Ferris MJ, Switchenko JM, et al. Prognostic value of radiographically defined extranodal extension in human papillomavirus-associated locally advanced oropharyngeal carcinoma. Head Neck. 2019. https://doi.org/10.1002/hed.25791.

    Article  Google Scholar 

  58. Bhattasali O, Thompson LDR, Schumacher AJ, Iganej S. Radiographic nodal prognostic factors in stage I HPV-related oropharyngeal squamous cell carcinoma. Head Neck. 2019;41:398–402.

    Google Scholar 

  59. Riaz N, Setton J, Tam M, et al. Patients with low lying lymph nodes are at high risk for distant metastasis in oropharyngeal cancer. Oral Oncol. 2014;50:863–8.

    Google Scholar 

  60. Nami Saber C, Gronhoj C, Jensen DH, et al. Synchronous, bilateral tonsillar carcinomas: patient characteristics and human papillomavirus genotypes. Oral Oncol. 2017;74:105–10.

    Google Scholar 

  61. Gelwan E, Malm IJ, Khararjian A, Fakhry C, Bishop JA, Westra WH. Nonuniform distribution of high-risk human papillomavirus in squamous cell carcinomas of the oropharynx: rethinking the anatomic boundaries of oral and oropharyngeal carcinoma from an oncologic HPV perspective. Am J Surg Pathol. 2017;41:1722–8.

    Google Scholar 

  62. Platek ME, Jayaprakash V, Gupta V, et al. Subsite variation in survival of oropharyngeal squamous cell carcinomas 2004 to 2011. Laryngoscope. 2017;127:1087–92.

    Google Scholar 

  63. Li H, Torabi SJ, Yarbrough WG, Mehra S, Osborn HA, Judson B. Association of human papillomavirus status at head and neck carcinoma subsites with overall survival. JAMA Otolaryngol Head Neck Surg. 2018;144:519–25.

    Google Scholar 

  64. Haeggblom L, Attoff T, Hammarstedt-Nordenvall L, Nasman A. Human papillomavirus and survival of patients per histological subsite of tonsillar squamous cell carcinoma. Cancer Med. 2018;7:1717–22.

    Google Scholar 

  65. Garnaes E, Frederiksen K, Kiss K, et al. Double positivity for HPV DNA/p16 in tonsillar and base of tongue cancer improves prognostication: insights from a large population-based study. Int J Cancer. 2016;139:2598–605.

    CAS  Google Scholar 

  66. Garnaes E, Kiss K, Andersen L, et al. A high and increasing HPV prevalence in tonsillar cancers in Eastern Denmark, 2000–2010: the largest registry-based study to date. Int J Cancer. 2015;136:2196–203.

    CAS  Google Scholar 

  67. Stevens TM, Bishop JA. HPV-related carcinomas of the head and neck: morphologic features, variants, and practical considerations for the surgical pathologist. Virchows Arch. 2017;471:295–307.

    Google Scholar 

  68. Lewis JS Jr, Thorstad WL, Chernock RD, et al. p16 positive oropharyngeal squamous cell carcinoma:an entity with a favorable prognosis regardless of tumor HPV status. Am J Surg Pathol. 2010;34:1088–96.

    Google Scholar 

  69. Singhi AD, Stelow EB, Mills SE, Westra WH. Lymphoepithelial-like carcinoma of the oropharynx: a morphologic variant of HPV-related head and neck carcinoma. Am J Surg Pathol. 2010;34:800–5.

    Google Scholar 

  70. Bates T, McQueen A, Iqbal MS, Kelly C, Robinson M. Small cell neuroendocrine carcinoma of the oropharynx harbouring oncogenic HPV-infection. Head Neck Pathol. 2014;8:127–31.

    Google Scholar 

  71. Kraft S, Faquin WC, Krane JF. HPV-associated neuroendocrine carcinoma of the oropharynx: a rare new entity with potentially aggressive clinical behavior. Am J Surg Pathol. 2012;36:321–30.

    Google Scholar 

  72. Haughey BH, Sinha P, Kallogjeri D, et al. Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx. Oral Oncol. 2016;62:11–9.

    CAS  Google Scholar 

  73. Chernock RD, Wang X, Gao G, et al. Detection and significance of human papillomavirus, CDKN2A(p16) and CDKN1A(p21) expression in squamous cell carcinoma of the larynx. Mod Pathol. 2013;26:223–31.

    CAS  Google Scholar 

  74. Lewis JS Jr. p16 Immunohistochemistry as a standalone test for risk stratification in oropharyngeal squamous cell carcinoma. Head Neck Pathol. 2012;6(Suppl 1):S75–82.

    Google Scholar 

  75. Lewis JS Jr, Chernock RD, Ma XJ, et al. Partial p16 staining in oropharyngeal squamous cell carcinoma: extent and pattern correlate with human papillomavirus RNA status. Mod Pathol. 2012;25:1212–20.

    CAS  Google Scholar 

  76. Kilic S, Kilic SS, Shah KP, et al. Predictors of clinicopathologic stage discrepancy in oropharyngeal squamous cell carcinoma: a national cancer database study. Otolaryngol Head Neck Surg. 2018;158:309–18.

    Google Scholar 

  77. Yoo SH, Ock CY, Keam B, et al. Poor prognostic factors in human papillomavirus-positive head and neck cancer: who might not be candidates for de-escalation treatment? Korean J Intern Med. 2018;34(6):1313–23.

    Google Scholar 

  78. Sekee TR, Burt FJ, Goedhals D, Goedhals J, Munsamy Y, Seedat RY. Human papillomavirus in head and neck squamous cell carcinomas in a South African cohort. Papillomavirus Res. 2018;6:58–62.

    Google Scholar 

  79. Yuan Y, Wang L, Li QX, Zhang JY, Xu ZX, Guo CB. Retrospective study of survival in human papillomavirus-negative oropharyngeal squamous cell carcinoma treated with primary surgery and associated prognostic factors. Onco Targets Ther. 2018;11:2355–62.

    Google Scholar 

  80. Haave H, Gulati S, Brekke J, Lybak S, Vintermyr OK, Aarstad HJ. Tumor stromal desmoplasia and inflammatory response uniquely predict survival with and without stratification for HPV tumor infection in OPSCC patients. Acta Otolaryngol. 2018;138:1035–42.

    CAS  Google Scholar 

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Acknowledgements

A special thanks to Mrs. Hannah B. Herrera-Canlas for her research assistance. The views expressed are those of the authors solely and do not represent endorsement from Southern California Permanente Medical Group. Presented at the 106th Annual Meeting of the United States and Canadian Academy of Pathology, Vancouver, British Columbia, Canada, March 19, 2018.

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This research is supported in part by a grant from the Regional Research Committee of Kaiser Permanente Southern California (KP-RRC-20161103).

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  1. Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, CA, 91365, USA

    Lester D. R. Thompson

  2. Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA

    Raoul Burchette

  3. Department of Radiation Oncology, Southern California Permanente Medical Group, Los Angeles, CA, USA

    Shawn Iganej & Onita Bhattasali

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Thompson, L.D.R., Burchette, R., Iganej, S. et al. Oropharyngeal Squamous Cell Carcinoma in 390 Patients: Analysis of Clinical and Histological Criteria Which Significantly Impact Outcome. Head and Neck Pathol 14, 666–688 (2020). https://doi.org/10.1007/s12105-019-01096-0

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