Differences in Functional and Survival Outcomes Between Patients Receiving Primary Surgery vs Chemoradiation Therapy for Treatment of T1-T2 Oropharyngeal Squamous Cell Carcinoma

Abstract

ImportanceDue to lack of data from high-powered randomized clinical trials, the differences in functional and survival outcomes for patients with oropharyngeal squamous cell carcinoma (OPSCC) undergoing primary transoral robotic surgery (TORS) vs primary radiation therapy and/or chemoradiation therapy (RT/CRT) are unclear.ObjectivesTo compare 5-year functional (dysphagia, tracheostomy dependence, and gastrostomy tube dependence) and survivorship outcomes in patients with T1-T2 OPSCC receiving primary TORS vs RT/CRT.Design, Setting, and PopulationThis national multicenter cohort study used data from a global health network (TriNetX) to identify differences in functional and survival outcomes among patients with OPSCC who underwent primary TORS or RT/CRT in 2002 to 2022. After propensity matching, 726 patients with OPSCC met inclusion criteria. In the TORS group, 363 (50%) patients had undergone primary surgery, and in the RT/CRT group, 363 (50%) patients had received primary RT/CRT. Data analyses were performed from December 2022 to January 2023 using the TriNetX platform.ExposurePrimary surgery with TORS or primary treatment with radiation therapy and/or chemoradiation therapy.Main Outcomes and MeasuresPropensity score matching was used to balance the 2 groups. Functional outcomes were measured at 6 months, 1 year, 3 years, 5 years, and more than 5 years posttreatment and included dysphagia, gastrostomy tube dependence, and tracheostomy dependence according to standard medical codes. Five-year overall survivorship was compared between patients undergoing primary TORS vs RT/CRT.ResultsPropensity score matching allowed a study sample with 2 cohorts comprising statistically similar parameters with 363 (50%) patients in each. Patients in the TORS cohort had a mean (SD) age of 68.5 (9.9) vs 68.8 (9.7) years in RT/CRT cohort; 86% and 88% were White individuals, respectively; 79% of patients were men in both cohorts. Primary TORS was associated with clinically meaningful increased risk of dysphagia at 6 months (OR, 1.37; 95% CI, 1.01-1.84) and 1 year posttreatment (OR, 1.71; 95% CI, 1.22-2.39) compared with primary RT/CRT. Patients receiving surgery were less likely to be gastrostomy tube dependent at 6 months (OR, 0.46; 95% CI, 0.21-1.00) and 5 years posttreatment (risk difference, −0.05; 95% CI, −0.07 to −0.02). Differences in overall rates of tracheostomy dependence (OR, 0.97; 95% CI, 0.51-1.82) between groups were not clinically meaningful. Patients with OPSCC, unmatched for cancer stage or human papillomavirus status, who received RT/CRT had worse 5-year overall survival than those who underwent primary surgery (70.2% vs 58.4%; hazard ratio, 0.56; 95% CI, 0.40-0.79).Conclusions and RelevanceThis national multicenter cohort study of patients undergoing primary TORS vs primary RT/CRT for T1-T2 OPSCC found that primary TORS was associated with a clinically meaningful increased risk of short-term dysphagia. Patients treated with primary RT/CRT had an increased risk of short- and long-term gastrostomy tube dependence and worse 5-year overall survival than those who underwent surgery.

Transoral robotic surgery in the diagnosis and treatment of primary unknown head and neck squamous cell carcinoma: A preliminary single centre experience

“…[18][19][20] Compared to radiotherapy alone, TORS also has advantages, Dev R Amin et al reported in 2023 that patients who received TORS surgery for T1-T2 oropharyngeal SCC had an decreased risk of shortterm and long-term gastrostomy tube dependence and better 5-year overall survival compared with patients who received radical radiotherapy. 21 Another randomised controlled trials reported by Anthony C Nichols in 2019 also showed that TORS combined with neck dissection had a lower incidence of neutropenia, hearing loss and tinnitus than radiotherapy alone. 22 In addition, It is worth emphasising that all 11 patients completed TORS and neck dissection at the same surgery.…”

Role of radiotherapy in early head and neck cancer

“…Sin embargo, la cirugía mediante un abordaje transoral se asocia a una morbilidad significativamente menor que la abierta (28,29) y puede considerarse un tratamiento electivo en función de la extensión y localización de la lesión. Aunque algún estudio retrospectivo ha mostrado una mayor supervivencia en tumores precoces con cirugía transoral frente a RTQT, los sesgos existentes no han permitido dilucidar qué herramienta terapéutica es la más conveniente (30)(31)(32).…”

Prevalence of neuromyelitis optica spectrum disorder in the United States

“…This database has been increasingly used to investigate pressing epidemiologic questions for diverse, complex, and acute conditions including outcomes related to cancer, SARS-CoV-2 infection, liver disease, cardiovascular health, and psychiatry conditions. [11][12][13][14][15] Here, we employed a descriptive framework similar to our prior investigation of the prevalence of MS, 16 including direct standardization to estimate the number of NMOSD cases in the United States in 2022.…”