Human Papillomavirus–Negative Oropharyngeal Cancer Survival Outcomes Based on Primary Treatment: National Cancer Database Analysis. (July 2022)

• Record Type: Journal Article
• Authors: Shama, Mohamed; Al-Qurayshi, Zaid; Dahl, Mohammad; Amdur, Robert J.; Bates, James; Mendenhall, William; Hitchcock, Kathryn; Festa, Bianca M.; Ghanem, Tamer; Dziegielewski, Peter T.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 167:Number 1(2022)
• Page Start: 100
• Page End: 108
• Publication Date: 2022-07
• Subjects: oropharyngeal cancer -- HPV (negative) -- surgery -- radiation -- chemoradiation; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/01945998211047169
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: To compare survival outcomes between primary surgery and primary radiation therapy (RT) in patients with human papillomavirus (HPV)–negative oropharyngeal squamous cell carcinoma (OPSCC). Study Design: A retrospective observational cohort study. Setting: National Cancer Database. Methods: A National Cancer Database review was conducted of 2635 patients with HPV-negative OPSCC who underwent surgery or RT ± chemotherapy between 2010 and 2014. Univariate analysis was performed on all variables and entered into a multivariate model. The main outcome was overall survival (OS). Results: A total of 2635 patients with HPV-negative OPSCC were organized into 4 groups based on cancer staging. In group 1 (T1-2 N0-1; n = 774), up-front surgery had significantly better 5-year OS (76.2%) than RT (56.8%; adjusted hazard ratio [aHR], 1.76; P = .009; 95% CI, 1.15-2.69) and chemoradiation therapy (CRT; 69.5%; aHR, 1.56; P = .019; 95% CI, 1.08-2.26). In group 2 (T3-4 N0-1; n = 327), no significant difference existed between surgery and CRT (5-year OS, 51.3% vs 52.4%; aHR, 0.96; P = .88; 95% CI, 0.54-1.69). In group 3a (T1-2 N2-3; n = 807), surgery with adjuvant treatment showed significantly better 5-year OS than CRT (78.6% vs 68.8%; aHR, 1.51; P = .027; 95% CI, 1.05-2.18). In group 3b (T3-4 N2-3; n = 737), surgery with adjuvant treatment was not statistically associated with better 5-year OS as compared with CRT (61.0% vs 43.7%; aHR, 1.53; P = .06; 95% CI, 0.98-2.39). Conclusion: Primary surgery may provide improved survival outcomes in many cases of HPV-negative OPSCCs. These data should be used in weighing treatment options and may serve as a basis to better delineate treatment algorithms for HPV-negative disease.