Primary surgery for human papillomavirus-associated oropharyngeal cancer: Survival outcomes with or without adjuvant treatment

Cramer, John D.; Ferris, Robert L.; Kim, Seungwon; Duvvuri, Umamaheswar

doi:10.1016/j.oraloncology.2018.10.039

Cited by 33 publications

(30 citation statements)

References 25 publications

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“…Current studies examining survival in OPSCC have been largely limited to retrospective review. Consistent with previous reports, our prospectively-collected study showed 3-year overall survival for patients undergoing TORS at 93.2% (p=0.02) (28,29). Recent AJCC staging recommendations suggest 3-year survival being an adequate measure of cure in this disease(16).…”

Section: Discussionsupporting

confidence: 88%

Transoral Robotic Surgery Versus Chemoradiation Treatment in Oropharyngeal Cancer: Case-matched Comparison of Survival and Swallowing Outcomes

Sommerfeld¹,

Jeffery²,

Jm³

et al. 2019

Preprint

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Background As the incidence of HPV/p16-positve oropharyngeal squamous cell carcinoma (OPSCC) continues to rise, a large population of survivors with treatment related morbidity is emerging. Transoral robotic surgery (TORS) is an excellent surgical option for p16-positive OPSCC but data comparing both survival and swallowing outcomes of this treatment versus radiotherapy/chemoradiotherapy (RT/CRT) remains limited. Methods Data was prospectively collected (05/2014 - 02/2019) in a tertiary care referral center from OPSCC patients treated with curative intent by TORS (+/-post-operative RT/CRT) or RT/CRT. Surgical and non-surgical treatment groups were case-matched for smoking status, T-stage, and N-stage based on AJCC 8th edition staging. Patients who were treated with curative intent by TORS (+/-post-operative RT/CRT) or RT/CRT for OPSCC were included. Overall survival, recurrence free survival, aspiration free survival and gastrostomy tube outcomes were compared using univariate and multivariate statistical analyses. Results A total of 82 patients treated with TORS were case-matched with 61 patients who received RT/CRT. TORS patients demonstrated a significantly (p=0.02) higher overall survival (OS) at 3 years (OS=93.2%) compared to RT/CRT patients (OS=78.9%). No statistically significant difference was seen in recurrence free survival when comparing the two groups. TORS patients demonstrated an aspiration free survival (AFS) of 64.7% compared to 26.1% in RT/CRT patients (p=0.02 Log-Rank, 0.018 Breslow). TORS patients also had significantly (p < 0.01) lower gastrostomy tube placement (13.4%) compared to RT/CRT (22.9%) at any point during treatment. Conclusion Patients undergoing treatment by TORS may have comparable survival and improved swallowing outcomes when compared to those undergoing RT/CRT for HPV-OPSCC.

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Section: Discussionsupporting

confidence: 88%

Transoral Robotic Surgery Versus Chemoradiation Treatment in Oropharyngeal Cancer: Case-matched Comparison of Survival and Swallowing Outcomes

Sommerfeld¹,

Jeffery²,

Jm³

et al. 2019

Preprint

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“…The association of LVI with poorer survival for the S + CRT group may warrant additional attention. Prior NCDB studies of HPV-related OPSCC did not find an association between LVI and poorer survival in low-risk/surgery-alone cohorts, 30,31 which are distinct from the S + CRT cohort of this study. Studies with larger HPV-related OPSCC NCDB cohorts did not examine LVI as a risk factor.…”

Section: Discussioncontrasting

confidence: 65%

Impact of Lymph Node Yield on Survival in Surgically Treated Oropharyngeal Squamous Cell Carcinoma

Gomez

Chang

Ceremsak

et al. 2020

Otolaryngol.--head neck surg.

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Objectives (1) To estimate the association between neck dissection lymph node yield (LNY) and survival among patients with surgically treated human papilloma virus (HPV)–associated oropharyngeal squamous cell carcinoma (OPSCC). (2) To identify a clinically relevant quality metric for surgical treatment of HPV-related OPSCC. Study Design Retrospective cohort study. Setting National Cancer Database. Subjects and Methods From the National Cancer Database, 4130 patients were identified with HPV-associated OPSCC treated with primary surgery from 2010 to 2016. Based on prior literature, an adequate neck dissection LNY was defined as ≥18 lymph nodes. To determine whether LNY is associated with survival, univariable and multivariable Cox proportional hazards regression was performed. Analysis was stratified by adjuvant therapy regimen. Results A total of 2113 patients (51.2%) underwent surgery with or without adjuvant radiation (S ± RT), and 2017 patients (48.8%) underwent surgery with adjuvant chemoradiation. LNY ≥18 was associated with a 5-year survival benefit of 7.15% (91.7% for LNY ≥18, 84.5% for LNY <18, P = .004) for the S ± RT cohort on unadjusted survival analysis. For the S ± RT group, LNY ≥18 was associated with decreased hazard of death (hazard ratio, 0.45; 95% CI, 0.29-0.70; P < .001) after adjustment for patient characteristics, TNM staging, surgical margins, extranodal extension, and treating facility characteristics. For surgery with adjuvant chemoradiation, the adjusted hazard ratio estimate for LNY ≥18 was 0.64 (95% CI, 0.41-1.00), but the result was not statistically significant ( P = .052). Conclusion An adequate LNY from a neck dissection may affect survival when HPV-related OPSCC is treated with up-front surgery.

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“…Both facility factors yielded a P value less than .2. On multivariable regression, patients with LVI were 1.6 times as likely to have [26][27][28][29][30][31][32][33][34][35].93], P < .001). When T4a and T4b were grouped into a single category on multivariable regression, T classification remained a significant predictor of margin status (for T4, OR: 6.94, CI: 3.14-15.30, P < .001), and the rest of the model was unchanged.…”

Section: Factors Associated With Positive Margins On Multivariable mentioning

confidence: 99%

Positive margin rates and predictors in transoral robotic surgery after federal approval: A national quality study

et al. 2019

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Background Purpose of the study is to assess nationwide margin performance in oropharynx transoral robotic surgery (TORS). Methods Retrospective review of the National Cancer Database. Results Two thousand six hundred sixty‐one patients were included. The national positive margin rate (PMR) was 16.9%. High‐volume facilities had a lower PMR than low‐volume facilities (12.7% vs 21.9%; P < .001). Patients with disease of the tonsil had a lower PMR (15.7%) than base‐of‐the‐tongue (18.2%; P = .14). PMR increased with T classification (T1 = 13.0%, T2 = 17.1%, T3 = 28.2%, T4a = 45.9%, T4b = 58.3%; P < .001). On multivariable regression, factors associated with margin status included only lymph‐vascular invasion (1.63[1.13‐2.36]; P = .01), high volume (0.57[0.36‐0.92]; P = .005), and T classification (as compared to T1, T2: 1.50[1.03‐2.18], T3: 3.11[1.77‐5.46], T4a: 7.03[2.95‐16.75], T4b: 6.72[1.26‐35.93]; P < .001). Conclusions National PMR is 16.9%, substantially higher than reported in high‐volume TORS centers. There is a linear association between positive margins and T classification, with T3 and T4 PMRs exceeding 28%. High‐volume facilities are half as likely to yield positive margins compared to low‐volume facilities. There was no association between human papilloma virus status, tumor subsite, or academic facility status and positive margins.

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Primary surgery for human papillomavirus-associated oropharyngeal cancer: Survival outcomes with or without adjuvant treatment

Cited by 33 publications

References 25 publications

Transoral Robotic Surgery Versus Chemoradiation Treatment in Oropharyngeal Cancer: Case-matched Comparison of Survival and Swallowing Outcomes

Transoral Robotic Surgery Versus Chemoradiation Treatment in Oropharyngeal Cancer: Case-matched Comparison of Survival and Swallowing Outcomes

Impact of Lymph Node Yield on Survival in Surgically Treated Oropharyngeal Squamous Cell Carcinoma

Positive margin rates and predictors in transoral robotic surgery after federal approval: A national quality study

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