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Upfront surgery does not improve OS for patients with HPV–negative OPSCC
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Upfront surgical resection did not improve OS compared with conventional concurrent chemoradiation therapy among patients with HPV–negative oropharyngeal squamous cell carcinoma, according to results of an observational study.
“The findings of this analysis do not negate the role of surgery in HPV–negative oropharyngeal squamous cell cancer [OPSCC]. Rather patients undergoing transoral robotic surgery who do not require concurrent chemoradiation [CRT] may have favorable quality of life in comparison with those receiving definitive CRT, a question currently under investigation,” Zain A. Husain, MD, assistant professor of therapeutic radiology, and director of the head and neck radiotherapy program at Smilow Cancer Hospital of Yale Cancer Center, and colleagues wrote. “However, our results suggest upfront surgery should not be recommended solely because it is felt to intensify therapy or because it is hypothesized to overcome perceived resistance mechanisms of tumors to CRT, which is particularly important as primary surgery for early-stage OPSCC is rising.”
Husain and colleagues used the National Cancer Data Base to evaluate data from 1,044 patients (median age, 59 years; range, 25-90; 77.8% men) diagnosed with cT1-2 N1-2b HPV–negative OPSCC between 2010 and 2012. Researchers compared OS rates of patients who underwent CRT (n = 460; 44.1%) with patients who underwent primary surgical resection (n = 584; 55.9%). Approximately 59% of patients who underwent surgery received adjuvant CRT.
Median follow-up was 30 months.
Among the entire cohort, the 3-year OS was 79.2% (95% CI, 74.5-82.9) for patients who received CRT and 81.4% (95% CI, 76.9-85.2) for patients who underwent upfront surgery.
Upfront surgery was not associated with improved OS compared with CRT by univariable analysis (HR = 0.93; 95% CI, 0.68-1.26) or multivariate analysis (HR = 1.01; 95% CI, 0.74-1.39). These results remained even after shared frailty was included.
Researchers then conducted propensity score matching to identify 822 matched patients representing the two treatments for comparison. This analysis showed similar OS between patients who underwent surgery and who received CRT (HR = 1.14; 95% CI, 0.81-1.62). Rates of 3-year OS were 81.3% (95% CI, 76.6-85.2) for patients who underwent surgery compared with 82.5% (95% CI, 77.4-86.6) for matched patients who received CRT.
In a subset analysis, improved OS was not observed in patients who underwent margin-negative resection (HR = 0.97; 95% CI, 0.66-1.45).
“Our data may have implications for future research focusing on optimal patient selection for surgery, as transoral robotic surgery shows promise in improving quality of life in patients requiring minimal adjuvant therapy,” the researchers concluded. – by Melinda Stevens
Disclosure: Husain reports research funding from Merck. One other researcher reports honoraria and travel expenses from Varian Medical Systems, Inc.
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