Transoral Surgery Versus Radiotherapy as Primary Treatment for HPV-Related Oropharyngeal Cancer in the Elderly

IF 2.2 3区医学 Q1 OTORHINOLARYNGOLOGY Head and Neck-Journal for the Sciences and Specialties of the Head and Neck Pub Date : 2025-02-07 DOI:10.1002/hed.28097

Andrea Costantino, Bruce Haughey, Jianbin Zhu, Uthman Alamoudi, J. Scott Magnuson

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Abstract

Background

This study compares the oncological outcomes of primary transoral surgery (TOS) and primary radiotherapy (RT) in elderly patients with HPV-related oropharyngeal squamous cell carcinoma (OPSCC).

Methods

This retrospective cohort study included patients with cT1-2 HPV-related OPSCC from the National Cancer Database (NCDB).

Results

A total of 2566 patients were included, with 73.9% receiving primary RT and 22.3% undergoing primary TOS. Subgroup analysis showed a higher 5-year overall survival (OS) rate for primary TOS (81.6%; 95% CI: 79.6%–83.6%) compared to primary RT (70.7%; 95% CI: 68.3%–73.1%), with an adjusted hazard ratio (HR) of 0.64 (95% CI: 0.50–0.81; p < 0.001) after propensity score matching. Notably, only (13.6%) of patients diagnosed in 2020 underwent primary TOS, with a significant decline over the study period.

Conclusions

This study suggests that primary TOS may offer better survival outcomes for elderly patients with HPV-related OPSCC compared to primary RT.

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经口手术与放疗作为老年人hpv相关口咽癌的主要治疗方法。

背景：本研究比较了原发性经口手术（TOS）和原发性放疗（RT）治疗老年hpv相关口咽鳞状细胞癌（OPSCC）患者的肿瘤预后。方法：这项回顾性队列研究纳入了来自国家癌症数据库（NCDB）的cT1-2 hpv相关OPSCC患者。结果：共纳入2566例患者，73.9%接受了原发性放疗，22.3%接受了原发性TOS。亚组分析显示原发性TOS患者的5年总生存率（OS）更高(81.6%；95% CI: 79.6%-83.6%)与初级RT (70.7%；95% CI: 68.3%-73.1%)，校正风险比（HR）为0.64 (95% CI: 0.50-0.81；结论：本研究表明，与原发性RT相比，原发性TOS可能为hpv相关的老年OPSCC患者提供更好的生存结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck 医学-耳鼻喉科学

CiteScore

7.00

自引率

6.90%

发文量

278

审稿时长

1.6 months

期刊介绍： Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.