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RTOG‐0129 risk groups are reproducible in a prospective multicenter heterogeneously treated cohort
Author(s) -
Fakhry Carole,
Tewari Sakshi R.,
Zhang Lisa,
Windon Melina J.,
Bigelow Elaine O.,
Drake Virginia E.,
Rooper Lisa M.,
Troy Tanya,
Ha Patrick,
Miles Brett A.,
Mydlarz Wojciech K.,
Eisele David W.,
D’Souza Gypsyamber
Publication year - 2021
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.33682
Subject(s) - medicine , hazard ratio , proportional hazards model , prospective cohort study , oncology , cancer , radiation therapy , univariate analysis , recursive partitioning , confidence interval , cohort , cohort study , multivariate analysis
Background Recursive partitioning analysis (RPA) from the Radiation Therapy Oncology Group (RTOG)‐0129 has identified a low‐risk group of patients with oropharynx cancer (OPC) who might benefit from therapeutic de‐intensification. These risk groups have not yet been reproduced in an independent cohort treated heterogeneously. Therefore, the objective of this analysis was to validate the RPA risk groups and examine the prognostic impact of novel factors. Methods Patients with OPC were enrolled in a prospective study at 3 academic medical centers from 2013 to 2018. Medical record abstraction was used to ascertain clinical variables including staging and survival according to the 7th edition of the American Joint Committee on Cancer ( AJCC ) Cancer Staging Manual . Human papillomavirus–positive tumor status was determined by p16 immunohistochemistry and/or HPV RNA in situ hybridization. Kaplan‐Meier and log‐rank methods were used to compare survival. Cox proportional hazards were used to generate univariate and multivariable hazard ratios (HRs). Results Median follow‐up time was 3.2 years. The low‐, intermediate‐, and high‐risk groups had significant differences in 2‐year overall survival (OS, 99.1%; 95% CI, 94.4%‐99.9% vs OS, 93.0%; 95% CI, 74.7%‐98.2% vs OS, 80.0%; 95% CI, 40.9%‐94.6%; P overall = .0001) and 2‐year progression‐free survival (PFS, 97.5%; 95% CI, 92.4%‐99.2% vs PFS, 89.3%; 95% CI, 70.3%‐96.4% vs PFS, 80.0%; 95% CI, 40.9%‐94.6%; P overall < .002). After adjustment for age, sex, and level of educational attainment, OS and PFS were significantly lower for the intermediate‐ (OS adjusted hazard ratio [aHR], 5.0; 95% CI, 1.0‐23.0; PFS aHR, 3.4; 95% CI, 1.0‐11.5), and high‐ (OS aHR, 7.3; 95% CI, 1.4‐39; PFS aHR, 5.0; 95% CI, 1.2‐21.6) risk groups compared with the low‐risk group. Lower education was also independently significantly associated with worse OS (aHR, 8.9; 95% CI, 1.8‐44.3) and PFS (aHR, 3.1; 95% CI, 1.0‐9.6). Conclusions In patients with OPC, the RTOG‐0129 RPA model is associated with OS and PFS in a heterogeneously treated cohort.