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Annals of Surgical Oncology

, Volume 24, Issue 12, pp 3494–3501 | Cite as

Transoral Resection of Human Papillomavirus (HPV)-Positive Squamous Cell Carcinoma of the Oropharynx: Outcomes with and Without Adjuvant Therapy

  • Ryan S. Jackson
  • Parul Sinha
  • Joseph Zenga
  • Dorina Kallogjeri
  • Jasmina Suko
  • Eliot Martin
  • Eric J. Moore
  • Bruce H. Haughey
Head and Neck Oncology
  • 327 Downloads

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.

Notes

Acknowledgement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Disclosure

There are no conflicts of interest.

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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Ryan S. Jackson
    • 1
  • Parul Sinha
    • 1
  • Joseph Zenga
    • 1
  • Dorina Kallogjeri
    • 1
    • 2
  • Jasmina Suko
    • 1
    • 2
  • Eliot Martin
    • 3
  • Eric J. Moore
    • 3
  • Bruce H. Haughey
    • 4
  1. 1.Department of Otolaryngology–Head and Neck SurgeryWashington University School of MedicineSt. LouisUSA
  2. 2.Clinical Outcomes Research OfficeWashington University School of MedicineSt. LouisUSA
  3. 3.Department of Otolaryngology–Head and Neck SurgeryMayo ClinicRochesterUSA
  4. 4.Head and Neck Surgery Center of FloridaFlorida Hospital Celebration Health and Florida Hospital Cancer InstituteCelebrationUSA

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