Research Article Outcome and Prognostic Factors in T4a Oropharyngeal Carcinoma, Including the Role of HPV Infection Georgios Psychogios, 1 Konstantinos Mantsopoulos, 1 Abbas Agaimy, 2 Kathrin Brunner, 2 Elisabeth Mangold, 1 Johannes Zenk, 1 and Heinrich Iro 1 1 Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Waldstraße 1, 91054 Erlangen, Germany 2 Institute of Pathology, Friedrich Alexander University of Erlangen-Nuremberg, Krankenhausstraße 10, 91054 Erlangen, Germany Correspondence should be addressed to Georgios Psychogios; gpsychogios@gmail.com Received 10 January 2014; Revised 12 February 2014; Accepted 14 February 2014; Published 31 March 2014 Academic Editor: Jan Plz´ ak Copyright © 2014 Georgios Psychogios et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. he prognosis of patients with advanced oropharyngeal carcinoma (OPSCC) is generally poor. he aim of this study is to investigate the diferent therapeutic approaches and identify prognostic factors associated with a worse outcome for patients treated for T4a OPSCC, in order to improve treatment selection for the individual. Methods. A retrospective study was conducted on 426 patients with T4a OPC treated between 1980 and 2010. Eleven prognostic factors including treatment modality, lymph node staging, and p16 status as a surrogate marker for human papillomavirus (HPV) infection were analyzed. Results. Univariate analysis showed a signiicant diference in DSS between N0 and N+ (57.1% versus 26.9%,  < 0.001), primary surgical and primary nonsurgical treatment (52.7% versus 31.4%,  < 0.001), and perinodal invasion (51.7% versus 19.9%,  = 0.011). P16-negative patients tended towards a worse DSS than p16-positive patients (40.2% versus 64.6%,  = 0.126) but responded better to primary surgery than to nonsurgical treatment (71.4% versus 34.0%,  = 0.113). Multivariate analysis identiied the N category as an independent prognostic factor for survival. Conclusion. he survival of p16-negative patients was worse than p16-positive patients, although they seem to respond better to primary surgery. he strongest independent prognostic factor for T4a carcinomas proved to be the presence of lymph node metastases. 1. Introduction he management of patients with locally advanced oropha- ryngeal squamous cell carcinoma (OPSCC) has evolved greatly. A decade ago, several studies showed that radio- therapy (RT) in combination with chemotherapy (CT) ofers oncologic and functional results similar to those of surgery but with lower severe complication rates [1–3]. Furthermore, in the light of increasing importance of human papillo- mavirus (HPV) infection in OPSCC and better survival ater radiochemotherapy (RCT) in this group of patients, primary RCT has emerged as treatment of choice for this subset of patients in many institutions [4, 5]. However, recent studies showed that both RT and CT can cause serious morbidity such as dysphagia, mandibular osteoradionecrosis, and pharyngeal strictures and may be associated with higher mortality rates [6, 7]. Furthermore the concept of organ preservation does not always coincide with function preservation. On the other hand, other studies have shown that the evolution of primary surgery, with the use of CO 2 laser, robotic surgery, and microvascular reconstruction, has reduced surgery-related morbidity and mortality and improved function with even better oncologic results in some cases [8–12]. he most appropriate treatment regimen is therefore still controversial. Prognostic factors are important in helping physicians to select the best treatment modality for the individual patient and for better planning of prospective studies. T4a tumors were irst deined in the 2002 TNM staging and represented a unique study group, because although the tumor has invaded critical structures it can still be resected surgically. To the best of our knowledge, this is the largest study to assess oncologic Hindawi Publishing Corporation BioMed Research International Volume 2014, Article ID 390825, 8 pages http://dx.doi.org/10.1155/2014/390825