Faculty Collaboration Database

Transoral Resection of Human Papillomavirus (HPV)-Positive Squamous Cell Carcinoma of the Oropharynx: Outcomes with and Without Adjuvant Therapy. Ann Surg Oncol 2017 Nov;24(12):3494-3501

Date

08/16/2017

Pubmed ID

28808988

Pubmed Central ID

PMC9012985

DOI

10.1245/s10434-017-6041-x

Scopus ID

2-s2.0-85028565847 (requires institutional sign-in at Scopus site)   23 Citations

Abstract

BACKGROUND: With the rise of oropharyngeal squamous cell carcinoma associated with human papillomavirus (HPV), appropriate treatment strategies continue to be tailored toward minimizing treatment while preserving oncologic outcomes. This study aimed to compare the outcomes for those undergoing transoral resection with or without adjuvant therapy for HPV-related oropharyngeal carcinoma.

METHODS: A case-match cohort analysis was performed at two institutions on patients with HPV-related oropharyngeal squamous cell carcinoma. All the subjects underwent transoral surgery and neck dissection. The patients treated with surgery alone were matched 1:1 to those treated with surgery and adjuvant therapy using two groups identified as confounders: T-stage (T1/2 or T3/4) and number of pathologically positive lymph nodes (≤4 or >4).

RESULTS: The study identified 105 matched pairs, with a median follow-up period of 42 months (range 3.1-102.3 months). The patients were staged as T1/T2 (86%) or T3/4 (14%). Each group had five patients with more than four positive lymph nodes. Adjuvant therapy significantly improved disease-free survival (hazard ratio [HR] 0.067; 95% confidence interval [CI] 0.01-0.62) and was associated with a lower risk of local and regional recurrence (risk ratio [RR] 0.096; 95% CI 0.02-0.47). No difference in disease-specific survival (HR 0.22; 95% CI 0.02-2.57) or overall survival (HR 0.18; 95% CI 0.01-2.4) was observed with the addition of adjuvant therapy. The risk of the gastrostomy tube was higher for those receiving adjuvant therapy (RR 7.3; 95% CI 2.6-20.6).

CONCLUSIONS: Transoral surgery is an effective approach for the treatment of HPV-related oropharyngeal carcinoma. The addition of adjuvant therapy appears to decrease the risk of recurrence and improve disease-free survival but may not significantly improve overall survival.

Author List

Jackson RS, Sinha P, Zenga J, Kallogjeri D, Suko J, Martin E, Moore EJ, Haughey BH

Author

Joseph Zenga MD Assistant Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Carcinoma, Squamous Cell
Case-Control Studies
Chemotherapy, Adjuvant
Combined Modality Therapy
Female
Follow-Up Studies
Humans
Male
Middle Aged
Mouth Neoplasms
Neoplasm Recurrence, Local
Oropharyngeal Neoplasms
Papillomaviridae
Papillomavirus Infections
Prognosis
Radiotherapy, Adjuvant
Retrospective Studies
Robotic Surgical Procedures
Survival Rate