Survival Worse in Patients With Rare Oropharyngeal Small-Cell Carcinoma

Oropharyngeal small-cell carcinoma was more likely to present as distant disease and was associated with worse survival outcomes compared with oropharyngeal squamous cell carcinoma, according to data in a research letter published in JAMA Otolaryngology – Head & Neck Surgery.

“The poor outcomes for small-cell carcinoma suggest the need for more aggressive therapy in this type of oropharyngeal cancer, especially given current trends of de-escalation of therapy for oropharyngeal cancer,” wrote researchers Uchechukwu C. Megwalu, MD, MPH, and Brian A. Nuyen, MD, of the department of otolaryngology – head and neck surgery at Stanford University School of Medicine in California.

Small-cell carcinoma is a neuroendocrine malignancy that usually presents in the lungs. However, rare cases of oropharyngeal small-cell carcinoma have been reported. Because there are limited data on this rare entity, it has been difficult to assess survival outcomes.

In this study, Megwalu and Nuyen looked at data from adult patients diagnosed with oropharyngeal small-cell or squamous cell carcinoma between 1973 and 2013 in the Surveillance, Epidemiology, and End Results (SEER) 18 Database. They identified 45 patients with oropharyngeal disease and 40,571 with squamous cell disease.

The incidence of oropharyngeal small-cell carcinoma was 0.003 per 100,000. These patients were more than three times as likely to present with distant disease compared with patients with squamous cell disease (odds ratio [OR], 3.76; 95% CI, 2.04–6.96). In addition, patients with small-cell disease were less likely to present with regional disease (OR, 0.34; 95% CI, 0.18–0.62).

Compared with patients with squamous cell disease, patients with small-cell disease had significantly worse overall survival rates (49.5% vs 19.5%) and disease-free survival rates (58.3% vs 24.1%). Multivariable analysis showed that patients with oropharyngeal small-cell carcinoma had a 67% increased risk for death (hazard ratio [HR] for overall survival, 1.67; 95% CI, 1.02–2.73) and an 80% increased risk for death from their disease (HR, 1.80; 95% CI, 1.06–3.03).