Head & neck · 2026
Smoking, Tumor Subsite, and Stage as Predictors of Second Primary Tumors in Oropharyngeal Squamous Cell Carcinoma (OPSCC): A Retrospective Cohort Study.
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da Silva Flávia Mince Azenha, Mortari Gabriel Riquieri, Buexm Luisa Aguirre, Carvalho Raiany Santos, Hirai Welinton Yoshio, de Oliveira Caroline, Ferigatto Júlia Lopes, de Lima Vazquez Fabiana, Coracin Fabio Luiz, de Matos Leandro Luongo, Gama Ricardo Ribeiro
Аннотация
BACKGROUND: Late detection of second primary tumors (SPTs) in survivors of oropharyngeal squamous cell carcinoma (OPSCC) remains a major clinical challenge, even during routine follow-up. This study aimed to develop a predictive risk model and a nomogram to estimate the likelihood of SPT development in patients with OPSCC.
METHODS: The authors conducted a retrospective cohort study of 514 consecutive patients diagnosed with OPSCC between 2008 and 2018. Sociodemographic and clinical data were obtained from medical records. Bidirectional cause-specific Cox regression analysis was used to identify independent risk factors for SPT development. A predictive nomogram was subsequently constructed based on the final model.
RESULTS: Among the 514 patients, 51 (9.9%) developed SPTs, most commonly in the head and neck region, esophagus, or lungs. The cohort was predominantly male (88.7%) with a median age of 58 years. Most tumors were p16-negative (76.7%) and presented at advanced stages (III-IV) in 74.9% of cases. The median time to SPT diagnosis was 34.6 months. Independent risk factors for SPT included a history of smoking (HR = 4.5, p = 0.14), primary tumors located in the soft palate, uvula, vallecula, posterior oropharyngeal wall, or unspecified oropharyngeal sites (HR = 2.17, p = 0.01), and advanced stage at diagnosis (HR = 2.19, p = 0.04).
CONCLUSIONS: Non-HPV-related OPSCC subsites, smoking history, and advanced tumor stage were independently associated with a higher risk of SPT. These variables were incorporated into a nomogram designed to support individualized surveillance and facilitate earlier SPT detection in high-risk patients.
METHODS: The authors conducted a retrospective cohort study of 514 consecutive patients diagnosed with OPSCC between 2008 and 2018. Sociodemographic and clinical data were obtained from medical records. Bidirectional cause-specific Cox regression analysis was used to identify independent risk factors for SPT development. A predictive nomogram was subsequently constructed based on the final model.
RESULTS: Among the 514 patients, 51 (9.9%) developed SPTs, most commonly in the head and neck region, esophagus, or lungs. The cohort was predominantly male (88.7%) with a median age of 58 years. Most tumors were p16-negative (76.7%) and presented at advanced stages (III-IV) in 74.9% of cases. The median time to SPT diagnosis was 34.6 months. Independent risk factors for SPT included a history of smoking (HR = 4.5, p = 0.14), primary tumors located in the soft palate, uvula, vallecula, posterior oropharyngeal wall, or unspecified oropharyngeal sites (HR = 2.17, p = 0.01), and advanced stage at diagnosis (HR = 2.19, p = 0.04).
CONCLUSIONS: Non-HPV-related OPSCC subsites, smoking history, and advanced tumor stage were independently associated with a higher risk of SPT. These variables were incorporated into a nomogram designed to support individualized surveillance and facilitate earlier SPT detection in high-risk patients.