Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P78

Head and Neck

P78		
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
poor prognosis. Tobacco and alcohol are classic risk factors, but
Results: Of the 4414 patients included, 1053 (24%) experirecently human papillomavirus (HPV) infection has increased
enced AE. The odds of POC among all age groups were 3.5%
specifically in oropharyngeal cancers and become an additional
higher in ASA 4 compared with ASA 3 (3.6% vs 7.1%, P <
risk factor. Here, we evaluated the number of Langerhans cells
.05). Similarly, for ages 40-69 RO and LOS rates were higher
(CD1a), macrophages (CD68), and Treg (Foxp3) in HNSCC
in ASA 4 compared with ASA 3, .75% (2.58 vs 1.84, P < .05)
and report their prognostic power alone and combined.
and 4.1% (11.75 vs 7.68, P < .05), respectively. As mFI-5
Methods: Our clinical series was composed of 238 HNSCCs
score increased there was a corresponding increase in POC
(110 oral cavity, 72 oropharynx, 18 hypopharynx, and 38 larfrom 1.43 to 1.61 to 2.77 (P < .05). No risk factor accurately
ynx). HPV was detected by polymerase chain reaction (PCR)
predicted RA.
and p16 immunohistochemistry (IHC). CD1a, CD68, and
Conclusions: Although increased rates of major surgical AE
Foxp3 were evaluated by IHC and counted in the intratumoral
occurred in patients over 65 years of age, particularly those >
compartment.
80, our study showed age alone was not an independent preResults: p16 overexpression was observed in 14 samples.
dictor of these complications in HNC patients. Conversely,
However, p16 was significantly associated with a high numboth risk assessment indices-mFI-5 and ASA-were signifiber of CD1 +, CD68 +, and Foxp3 + cells (P = .011, .001, and
cant predictors of POC and therefore should be used to coun.007, respectively). Univariate Cox regression analyses demsel patients considered for major HNC surgery.
onstrated that high CD1a+ cell number was associated with
longer overall survival (OS), whereas high CD68+ and low
Risk Factors for Chronic Opioid Use in
Foxp3 + numbers were correlated with a better prognosis (P =
Head and Neck Cancer Patients
.004 and P = .009, respectively). Multivariate analysis conCraig A. Bollig, MD (Presenter); Brian Kinealy;
firmed that CD68 and Treg were independent prognosis facDavid R. Gilley, MD; Andre Clark; Greg Biederman, MD;
tors (P = .001 and P = .003, respectively). The combination of
Jeffrey B. Jorgensen, MD
these three markers in an immune score revealed a high and
Objectives: Previous studies have investigated chronic use
significant association with OS (P < .001, hazard ratio [HR] =
of
opioids
in head and neck cancer (HNC) patients, but most
3.46) in a univariate analysis. Such immune score stayed sighave
been
focused
on a single subsite and/or treatment modalnificant (P = .005, HR = 4.57) in comparison with p16,
ity.
As
a
result,
there
is little known regarding the relationship
tobacco, or alcohol (all NS) in a multivariate analysis.
between
these
clinical
factors and chronic opioid use.
Conclusions: Our immune score combining CD1a, CD68,
Methods:
A
total
of
388 patients with HNC treated at an
and Foxp3 immunostaining should be proposed to better
academic
center
between
2011 and 2017 were retrospectively
refine the prognosis of our HNSCC patients. Larger clinical
reviewed.
Tumor
subsite,
treatment modality, and other cliniseries should validate these findings.
copathologic factors were tested for associations with opioid
use at 3 and 6 months using univariate and multivariate
Risk Assessment in Major Head and Neck
analyses.
Oncologic Surgery
Results: The prevalence of opioid use was 43.0% at 3
Rachel T. Irizarry, MD (Presenter); Jennifer J. Liang, MD;
months and 33.2% at 6 months, respectively. On multivariate
Lousette Saint Victor, MPH; Lori Hoepner, DrPH, MPH;
analysis, primary chemoradiation (CRT) (odds ratio [OR] =
Natalya Chernichenko, MD
4.04; 95% CI, 1.91-8.55), surgery with adjuvant CRT (OR =
Objectives: Identifying patients at increased risk of periop2.39; 95% CI, 1.09-5.26), pretreatment opioid use (OR = 7.63;
erative adverse events (AE) is imperative to properly counsel
95% CI, 4.09-14.21), and younger age (OR = 0.97; 95% CI,
those offered major head and neck oncologic surgery. Age,
0.94-0.99) were associated with opioid use at 3 months. At 6
comorbidity, and frailty are well-established risk factors for
months, primary CRT (OR = 2.40; 95% CI, 1.34-4.28), presurgical morbidity. Yet, few large-scale studies have analyzed
treatment opioid use (OR = 5.86; 95% CI, 3.30-10.38),
and compared their predictive value in head and neck cancer
tobacco use (OR = 2.00; 95% CI, 1.18-3.40), and a psychiatric
(HNC) patients specifically.
disorder (OR = 1.79; 95% CI, 1.02-3.14) were associated with
Methods: A retrospective cohort study using the American
opioid use.
College of Surgeons National Surgical Quality Improvement
Conclusions: Patients with HNC are at high risk for chronic
Program (ACS NSQIP) database from 2007 to 2017 categoopioid use after treatment. Among the treatment modalities,
rized patients who underwent major HNC surgery into 4 age
primary CRT was associated with the highest rates of opioid
groups: < 40, 41-64, 65-79, and > 80. American Society of
use and was independently associated with opioid use at both
Anesthesiologists (ASA) score and modified frailty index-5
time points. Pretreatment opioid use remains the strongest
(mFI-5) score were recorded and compared with major postpredictor of chronic opioid use, but other risk factors include
operative AE characterized as postoperative complications
tobacco use and a psychiatric disorder. Preventative strategies
(POC), extended length of stay (LOS), reoperation (RO), or
should be focused toward these patients to reduce their risk of
readmission (RA).
long-term opioid use.
Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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