Similar Survival With Surgery and Chemoradiotherapy in HPV-Negative Oropharyngeal Squamous Cell Cancer

Key Points

  • No overall survival difference was observed between upfront surgery and definitive chemoradiotherapy among all patients with newly diagnosed HPV-negative oropharyngeal squamous cell carcinoma.
  • No overall survival difference was observed in propensity score–matched analysis.

In an observational study reported in JAMA Oncology, Kelly et al found that overall survival was similar with upfront surgery and definitive chemoradiotherapy among patients with newly diagnosed cT1–2 N1–2b human papillomavirus (HPV)-negative oropharyngeal squamous cell carcinoma.

Study Details

The study involved 1,044 patients from the National Cancer Database who were newly diagnosed between 2010 and 2012. Among them, 460 patients (44.1%) received upfront surgery, and 584 patients (55.9%) received chemoradiotherapy. Median age was 59 years (range, 25–90 years), and 77.8% were male. Adjuvant chemoradiotherapy was received by 59% of surgical patients.

Survival Outcomes

Median follow-up was 30 months. Overall, 3-year overall survival was 81.4% in the surgery group vs 79.2% in the chemoradiotherapy group (P = .65). On multivariable analysis, the adjusted hazard ratio for death for surgery vs chemoradiotherapy was 1.01 (P = .93). In a propensity score–matched cohort of 822 patients, the hazard ratio was 1.14 (P = .46; 3-year overall survival = 81.3% vs 82.5%). In the 331 surgical patients with margin-negative resection, hazard ratios were 0.97 (P = .88) on multivariable analysis and 0.80 (P = .39) on propensity score–matched analysis.

The investigators concluded: “In this observational study, [overall survival] was similar for patients with HPV-negative [oropharyngeal squamous cell carcinoma] when treated with primary surgery vs [chemoradiotherapy]. Most surgical patients received trimodal therapy with adjuvant [chemoradiotherapy]. Our data may have implications for future research focusing on optimal patient selection for surgery.”

Zain A. Husain, MD, of Yale Cancer Center, is the corresponding author of the JAMA Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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