HPV-negative OPSCC survival comparable with upfront surgery and CRT
medwireNews: A US research team has found no significant difference in overall survival (OS) between patients with human papillomavirus (HPV)-negative early-stage oropharyngeal squamous cell carcinoma (OPSCC) who received upfront surgery and those given concurrent chemoradiation (CRT).
The investigators do not think that the findings negate the role of surgery in this patient population, as “patients undergoing [transoral robotic surgery] who do not require adjuvant CRT may have favorable quality of life in comparison with those receiving definitive CRT,” they explain in JAMA Oncology.
“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. Rather, treatment recommendations should be based on factors such as patient preference, extent of disease, and the presence of radiographic [extracapsular extension].”
The team, from the Yale School of Medicine in New Haven, Connecticut, collated information from the National Cancer Database on 1044 patients (78% men) with HPV-negative cT1–2 N1–2b OPSCC, 44% of whom underwent surgery whereas the remaining 56% received CRT.
Three-year OS was 81.4% for patients who received upfront surgery and a comparable 79.2% for CRT-treated participants, and surgical management was not associated with improved OS relative to CRT in either univariate or multivariate analysis (respective nonsignificant hazard ratios [HRs] of 0.93 and 1.01).
The results were similar in a propensity score matched subcohort comprising 822 participants, with 3-year OS rates of 81.3% and 82.5% for the upfront surgery and CRT groups (HR=1.14), respectively, and also in a sensitivity analysis including only patients with negative surgical analysis (multivariate HR=0.97). These findings suggest that “lack of OS benefit is not a reflection of poor surgical quality,” say Zain Husain and co-authors.
And they conclude: “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.”
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