Patterns of care and perioperative outcomes in transoral endoscopic surgery for oropharyngeal squamous cell carcinoma

Zevallos, José P.; Mitra, Nandita; Swisher‐McClure, Samuel

doi:10.1002/hed.23909

Cited by 39 publications

(41 citation statements)

References 40 publications

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“…Third, although physician specialty, an important predictor for staging [32], [33] and OVCA cancer outcomes [20], [37]–[39], was not available, we used average facility-case volume as a proxy to minimize this bias, as it has been demonstrated in multiple analyses that a low institutional case volume reflects a lack of gynecologic oncology subspecialty care. [21]–[23] Fourth, although ORs may overestimate the relationship between race and diagnosis stage if the outcomes are highly prevalent, use of ORs is consistent with previous NCDB literature. [12], [39] Lastly, the NCDB does not include cases reported by non-approved hospitals, notably community hospitals serving minorities and women from lower SES groups, so results may be underestimated.…”

Section: Discussionsupporting

confidence: 69%

“…Treatment facility case-volume was used as a proxy for surgeon experience. [21] – [23] It was defined using the average annual number of patients diagnosed with OVCA at each facility and analyzed in quartiles of case-volume (quartile distribution of cases per year: 1st = 0–7, 2nd = 8–16, 3rd = 17 – 28 and 4th ≥ 29). Census-derived facility region was used as a proxy for healthcare access.…”

Section: Methodsmentioning

confidence: 99%

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The effect of time on racial differences in epithelial ovarian cancer (OVCA) diagnosis stage, overall and by histologic subtypes: a study of the National Cancer Database

Beckmeyer-Borowko

Peterson

Brewer

et al. 2016

Cancer Causes Control

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PURPOSE Previous studies assessing racial and ethnic differences in ovarian cancer (OVCA) diagnosis stage fail to present subtype-specific results and provide historic data on cases diagnosed between ten and twenty years ago. The purpose of this analysis is to assess non-Hispanic Black (NHB) and non-Hispanic White (NHW) differences in late stage diagnosis including; 1) factors associated with late-stage diagnosis of invasive epithelial OVCA overall and by histologic subtypes 2) potential changes across time, and, 3) current patterns of trends in a national cancer registry in the US and Puerto Rico between 1998 and 2011. METHODS NHB and NHW OVCA cases were derived from the National Cancer Database (NCDB). Diagnosis stage was analyzed as a dichotomous and a four-level category variable, respectively; early (stages I and II; localized) versus late (stages III and IV; regional and distant) and stages I, II, III and IV. Diagnosis period was trichotomized (1998–2002, 2003–2007, 2008–2011). Racial differences in stage were tested using Chi-square statistics. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated using multivariable binomial and generalized ordered logistic regressions. Interactions between race and diagnosis period were evaluated. RESULTS Between 1998 and 2011, 11,562 (7.8%) NHB and 137,106 (92.2%) NHW were diagnosed with OVCA. In adjusted models, NHB were significantly more likely diagnosed with late-stage OVCA than NHW (ORadj=1.26; 95%CI 1.19–1.33). Interaction between race and diagnosis period was marginally significant (pvalue=0.09), with racial differences in stage decreasing over time (1998–2002: ORadj= 1.36, 95%CI= 1.23–1.49; 2003–2007: ORadj= 1.27, 95%CI= 1.15–1.39; 2008–2011; ORadj =1.15, 95%CI= 1.05–1.27). NHB were also more likely to be diagnosed with stage 4 high grade serous (ORadj=1.46; 95%CI 1.22–1.74), clear cell (ORadj=2.71; 95%CI 1.94 – 3.79) and mucinous (ORadj=2.78; 95%CI 2.24 – 3.46) carcinomas than NHW. CONCLUSIONS Racial differences in late-stage OVCA diagnosis exist; however, these differences are decreasing with time. Within NCDB, NHB are significantly more likely diagnosed with late-stage OVCA and more specifically high-grade serous, clear cell and mucinous carcinomas than NHW.

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Section: Discussionsupporting

confidence: 69%

Section: Methodsmentioning

confidence: 99%

The effect of time on racial differences in epithelial ovarian cancer (OVCA) diagnosis stage, overall and by histologic subtypes: a study of the National Cancer Database

Beckmeyer-Borowko

Peterson

Brewer

et al. 2016

Cancer Causes Control

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“…Very few studies compare the outcomes of TORS to TLM, but one such study with 10 participants (10 in each surgical modality) found more positive margins in cases that utilized TORS but also found that disease‐free survival was increased within the TORS group . However, a larger 2010 to 2011 National Cancer Database (NCDB) study comparing the two modalities found TORS to have a lower likelihood of positive margins upon univariate analysis ( P = 0.003) but not multivariate analysis . Weinstein et al argue that this is because removal of the tumor en bloc is more manageable with TORS, which aids the pathologist in correctly determining margins.…”

Section: Introductionmentioning

confidence: 99%

Clinical value of transoral robotic surgery: Nationwide results from the first 5 years of adoption

Torabi

Park

et al. 2018

The Laryngoscope

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Objectives To compare long‐term oncologic outcomes and adjuvant therapies for patients treated with transoral robotic surgery (TORS), nonrobotic surgery, or transoral laser microsurgery (TLM). Study Design A retrospective analysis of the National Cancer Database (2010–2014). Methods Patients with clinical tumor (T)1 and T2 oropharyngeal squamous cell carcinomas (OPSCC) were classified into those receiving TORS versus nonrobotic surgery versus TLM. Univariate and multivariate survival analyses were conducted with chi‐square tests; Kaplan‐Meier log‐rank test; and Cox multivariate, logistic regression, and multinomial regression modeling. Results We identified 2,224 OPSCC TORS patients; 6,697 nonrobotic surgery patients; and 333 TLM patients. The majority of patients were white males with a mean age of approximately 59 years. No significant difference was noted between the cohorts in tumor stage; however, TORS patients were more likely to have nodal (N)1 to N3 disease than nonrobotic surgery and TLM patients, respectively (69.8% vs. 62.0% vs. 59.7%, P < 0.001). TORS was associated with a lower likelihood of positive margins when compared to nonrobotic surgery, although not TLM (nonrobotic surgery: hazard ratio [HR] 1.51, P < 0.001, TLM: HR 1.13, P = 0.582). TORS was associated with lower likelihood of postsurgical chemoradiotherapy (TLM: HR 2.07, P < 0.001, nonrobotic surgery: 1.65, P < 0.001) but not adjuvant radiotherapy alone (TLM: HR 1.06, P = 0.569, nonrobotic surgery: 0.96, P = 0.655). On multivariate Cox analysis of overall survival, the use of TORS was not associated with increased survival (TLM: HR 1.31, P = 0.233, nonrobotic surgery: HR 1.12, P < 0.303). Conclusion The advantages of TORS for early‐stage OPSCC may be a lower likelihood of postsurgical positive margins and subsequent need for adjuvant chemoradiotherapy. Level of Evidence NALaryngoscope, 129:1844–1855, 2019

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“…Transoral laser techniques have been adapted to the oropharynx over the past decade [28], and although a small number of centers have described good results over a large number of cases, [29] these techniques have not been widely applied across the population. Robotic surgery has become more common recently [30], but was much less common until FDA approval in 2010. Analysis of those trends would require more recent data than was available to us.…”

Section: Discussionmentioning

confidence: 99%

Treatment selection in oropharyngeal cancer: a surveillance, epidemiology, and end results (SEER) patterns of care analysis

Pagedar

Chioreso

Schlichting

et al. 2017

Cancer Causes Control

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Purpose Treatment for oropharyngeal cancer (OPC) has changed over the past two decades under multiple influences. We provide a population-based description of the application of radiotherapy, surgery, and chemotherapy to OPC in 1997, 2004 and 2009. Methods The National Cancer Institute’s Patterns of Care study for OPC included multiple variables not available in the public-use dataset. We identified factors correlating with selection of primary surgery versus radiotherapy with or without chemotherapy (RTC) and analyzed predictors of all-cause mortality. We estimated the frequency of human papillomavirus (HPV) testing. Results RTC was more common in 2009 than in 1997, and was more commonly applied to Stage IV cases. However, RTC was not an independent risk factor for mortality compared with surgery. HPV status was known in 14% of patients in 2009. Conclusions RTC is the most common treatment for OPC, but it may not provide the best outcomes. HPV testing was uncommon in 2009.

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Patterns of care and perioperative outcomes in transoral endoscopic surgery for oropharyngeal squamous cell carcinoma

Cited by 39 publications

References 40 publications

The effect of time on racial differences in epithelial ovarian cancer (OVCA) diagnosis stage, overall and by histologic subtypes: a study of the National Cancer Database

The effect of time on racial differences in epithelial ovarian cancer (OVCA) diagnosis stage, overall and by histologic subtypes: a study of the National Cancer Database

Clinical value of transoral robotic surgery: Nationwide results from the first 5 years of adoption

Treatment selection in oropharyngeal cancer: a surveillance, epidemiology, and end results (SEER) patterns of care analysis

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