Margin Status and Recurrence in Surgically Treated Patients With HPV+ Oropharyngeal Cancer

IF 2 3区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Laryngoscope Pub Date : 2025-03-04 DOI:10.1002/lary.32091

Madeleine Ausburn, Justin M. Pyne, Andrew T. Day, Natalia Hajnas, Dominic Moon, Larry Leonard Myers, David Jonathan Sher, John M. Truelson, Brittny Tillman, Baran Sumer

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Abstract

Background

The optimal margins for surgically treated human papilloma virus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) remain undefined. We evaluated the impact of surgical margins on progression-free survival (PFS) in patients with HPV+ OPSCC treated with primary transoral robotic surgery (TORS).

Methods

Patients undergoing primary TORS from May 2012 to December 2021 for intermediate-risk (T1–T2, resected to clear (≥ 3 mm) or close margins (< 3 mm), and N1-N2) HPV+ OPSCC were included. Survival outcomes were reviewed, and overall and PFS at 3 years posttreatment were determined using Kaplan–Meier analysis.

Results

A total of 69 subjects met inclusion criteria. At a median follow-up of 47 months, overall survival (OS) was 100%, and the PFS was 88.9% for the entire subject group. Among subjects not receiving adjunctive radiotherapy (RT), those with close margins had an OS of 100% and a PFS of 100% (median follow-up 47 months). Subjects with clear margins had an OS probability of 100% and a PFS probability of 100% (median follow-up 47 months).

Conclusion

In subjects undergoing TORS for HPV+ OPSCC, clear margins did not confer a significant OS or PFS survival advantage compared to those with close margins, even when adjuvant therapy was omitted.

Level of Evidence

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HPV+口咽癌手术治疗患者的边缘状态和复发情况

背景：手术治疗人乳头瘤病毒（HPV）相关口咽鳞状细胞癌（OPSCC）的最佳边缘仍未确定。我们评估了手术切缘对接受原发性经口机器人手术（TORS）治疗的HPV+ OPSCC患者的无进展生存期（PFS）的影响。方法：2012年5月至2021年12月期间接受初级TORS治疗的中危(T1-T2，切除清（≥3 mm）或近切缘的患者（结果：共有69例受试者符合纳入标准）。在中位随访47个月时，整个受试者组的总生存率（OS）为100%，PFS为88.9%。在未接受辅助放疗（RT）的受试者中，切缘接近的患者的OS为100%，PFS为100%（中位随访47个月）。有明显边缘的受试者的OS概率为100%，PFS概率为100%（中位随访47个月）。结论：在接受tor治疗的HPV+ OPSCC患者中，与边缘较近的患者相比，边缘清晰的患者即使在省略辅助治疗的情况下，也没有显著的OS或PFS生存优势。证据等级：3；

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来源期刊

Laryngoscope 医学-耳鼻喉科学

CiteScore

6.50

自引率

7.70%

发文量

500

审稿时长

2-4 weeks

期刊介绍： The Laryngoscope has been the leading source of information on advances in the diagnosis and treatment of head and neck disorders since 1890. The Laryngoscope is the first choice among otolaryngologists for publication of their important findings and techniques. Each monthly issue of The Laryngoscope features peer-reviewed medical, clinical, and research contributions in general otolaryngology, allergy/rhinology, otology/neurotology, laryngology/bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. Contributions include papers and posters presented at the Annual and Section Meetings of the Triological Society, as well as independent papers, "How I Do It", "Triological Best Practice" articles, and contemporary reviews. Theses authored by the Triological Society’s new Fellows as well as papers presented at meetings of the American Laryngological Association are published in The Laryngoscope. • Broncho-esophagology • Communicative disorders • Head and neck surgery • Plastic and reconstructive facial surgery • Oncology • Speech and hearing defects