BACKGROUND Human papillomavirus (HPV)-mediated oropharyngeal cancer (OPC) is associated with dramatically improved survival in comparison with HPV-negative OPC and can be successfully treated with surgical and nonsurgical approaches. National treatment trends for OPC were investigated with the National Cancer Data Base (NCDB). METHODS The NCDB was reviewed for primary HPV-mediated OPC in 2010-2014. Multivariable regression was used to identify predictors of both nonsurgical therapy and receipt of adjuvant chemoradiation (CRT). RESULTS There were 13,363 patients identified with a median age at diagnosis of 58 years. The incidence of triple-modality treatment (surgery with adjuvant chemotherapy) decreased from 23.7% in 2010 to 16.9% in 2014 (R2 = 0.96), whereas the incidence of nonsurgical treatment increased from 63.9% to 68.7% (R2 = 0.89). Hospitals in the top treatment volume quartile (quartile 1 [Q1]; n = 29) had a lower rate of positive margins (16.3%) than bottom-quartile centers (n = 741; rate of positive margins, 36.4%; P < .001); Q1 hospitals used surgical therapy significantly more. Independent predictors of nonsurgical therapy included older age, advanced disease, lower hospital volume, and living closer to the hospital or outside the Pacific United States. In surgically treated patients, younger age, lower hospital volume, nodal disease, positive surgical margins, and extranodal extension (ENE) also predicted more adjuvant CRT use. CONCLUSIONS The use of upfront surgical treatment decreased from 2010 to 2014. Hospital volume shows a strong, inverse correlation with the rate of positive surgical margins. The upfront treatment strategy is predicted not only by staging but also by patient-, geographic-, and hospital-specific factors. Lower hospital volume remains independently associated with increased triple-modality therapy after adjustments for positive margins, ENE, and pathologic staging.

中文翻译：

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人乳头瘤病毒阳性口咽鳞状细胞癌的全国治疗趋势。

背景技术与HPV阴性的OPC相比，人乳头瘤病毒（HPV）介导的口咽癌（OPC）与存活率显着提高有关，并且可以通过手术和非手术方法成功治疗。国家癌症数据库（NCDB）对OPC的国民治疗趋势进行了调查。方法在2010-2014年间，对NCDB进行了原发性HPV介导的OPC的审查。多变量回归用于确定非手术治疗和辅助放化疗（CRT）的预测因素。结果共有13363例患者，诊断中位年龄为58岁。三联疗法（辅助化疗手术）的发生率从2010年的23.7％下降到2014年的16.9％（R2 = 0.96），而非手术治疗的发生率从63.9％增加到68.7％（R2 = 0.89）。处于最高治疗量四分位数（四分位数1 [Q1]； n = 29）中的医院的阳性边际率（16.3％）低于底部四分位数中心（n = 741；阳性边际率，36.4％； P <）。 001）; Q1医院使用手术疗法的比例明显更高。非手术治疗的独立预测因素包括年龄较大，疾病晚期，住院量减少以及居住在医院附近或美国太平洋以外地区。在接受手术治疗的患者中，年龄较小，医院规模较小，淋巴结疾病，手术切缘阳性和结外扩展（ENE）也预示着更多的辅助CRT使用。结论从2010年到2014年，使用前期手术治疗的人数有所减少。医院的住院人数与手术切缘阳性率呈强烈反比关系。不仅可以通过分期来预测前期治疗策略，还可以根据患者，地理和医院特有的因素来预测前期的治疗策略。在调整了阳性切缘，ENE和病理分期后，较低的医院容量仍与增加三联疗法相联系。