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Original Investigation |

Initial Symptoms in Patients With HPV-Positive and HPV-Negative Oropharyngeal Cancer

Wesley R. McIlwain, BS1; Amit J. Sood, BA1; Shaun A. Nguyen, MD, MA1; Terry A. Day, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
JAMA Otolaryngol Head Neck Surg. 2014;140(5):441-447. doi:10.1001/jamaoto.2014.141.
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Importance  This study addresses the most common initial symptoms of oropharyngeal squamous cell carcinoma (OPSCC) and investigates differences between human papillomavirus (HPV)–positive vs HPV-negative tumors.

Objectives  To analyze the most common initial symptoms in patients with OPSCC and to determine if any differences in initial symptoms occur between HPV-positive and HPV-negative tumors.

Design, Setting, and Patients  Retrospective single-institution review of medical records of previously untreated patients with OPSCC diagnosed from January 1, 2008, to May 20, 2013, who were evaluated by 1 physician (the senior author, T.A.D.) at the Medical University of South Carolina.

Main Outcomes and Measures  We determined the most common initial symptoms of OPSCC and analyzed differences between HPV-positive and HPV-negative tumors.

Results  Neck mass (in 39 patients [44%]) and sore throat (in 29 patients [33%]) comprised the most common initial symptoms in OPSCC. Patients who were HPV-positive were more likely to initially notice a neck mass than HPV-negative patients (51% vs 18%; P = .02), whereas HPV-negative patients were more likely to notice sore throat (53% vs 28%; P = .09), dysphagia (41% vs 10%; P = .05), or odynophagia (24% vs 6%; P = .04).

Conclusions and Relevance  This study provides preliminary evidence supporting neck mass and sore throat as the initial symptoms of patients with OPSCC. Patients who were HPV-positive more commonly complained of a neck mass as the initial symptom, whereas HPV-negative patients more commonly had symptoms related to the primary tumor site, including sore throat, dysphagia, and/or odynophagia.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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