University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France.
Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France.
Eur J Surg Oncol. 2021 Feb;47(2):367-374. doi: 10.1016/j.ejso.2020.07.034. Epub 2020 Sep 10.
Therapeutic management of oropharyngeal squamous cell carcinomas (OPSCC) is still debated. Since the role of HPV was demonstrated, few studies have focused on HPV-negative OPSCC. The aim of our study was to assess the impact of therapeutic strategy (surgical vs. non-surgical) on oncologic outcomes in patients with HPV-negative OPSCC.
All p16-negative OPSCCs treated from 2009 to 2014 in 7 tertiary-care centers were included in this retrospective study and were classified according to the therapeutic strategy: surgical strategy (surgery ± adjuvant radiotherapy and chemotherapy) vs. non-surgical strategy (definitive radiotherapy ± chemotherapy). Patients not eligible for surgery (unresectable tumor, poor general-health status) were excluded. Univariate, multivariate and propensity score matching analyses were performed to compare overall (OS), disease-specific (DSS) and recurrence-free survival (RFS).
Four hundred seventy-four (474) patients were included in the study (surgical group: 196; non-surgical group: 278). Five-year OS, DSS and RFS were 76.5, 81.3 and 61.3%, respectively, in the surgical group and 49.9, 61.8 and 43.4%, respectively, in the non-surgical group. The favorable impact of primary surgical treatment on oncologic outcomes was statistically significant after multivariate analysis. This effect was more marked for locally-advanced than for early-stage tumors. Propensity score matching analysis confirmed the prognostic impact of primary surgical treatment for RFS.
Therapeutic strategy is an independent prognostic factor in patients with p16-negative OPSCC and primary surgical treatment is associated with improved OS, DSS and RFS. These results suggest that surgical strategy is a reliable option for advanced stage OPSCC.
口咽鳞状细胞癌（OPSCC）的治疗管理仍存在争议。自从 HPV 作用被证实以来，很少有研究关注 HPV 阴性 OPSCC。我们的研究目的是评估治疗策略（手术与非手术）对 HPV 阴性 OPSCC 患者肿瘤学结局的影响。
本回顾性研究纳入了 2009 年至 2014 年在 7 家三级保健中心治疗的所有 p16 阴性 OPSCC，并根据治疗策略进行分类：手术策略（手术±辅助放疗和化疗）与非手术策略（根治性放疗±化疗）。不适合手术（不可切除的肿瘤、一般健康状况差）的患者被排除在外。进行了单变量、多变量和倾向评分匹配分析，以比较总生存期（OS）、疾病特异性生存期（DSS）和无复发生存期（RFS）。
本研究共纳入 474 例患者（手术组 196 例，非手术组 278 例）。手术组 5 年 OS、DSS 和 RFS 分别为 76.5%、81.3%和 61.3%，非手术组分别为 49.9%、61.8%和 43.4%。多变量分析表明，原发手术治疗对肿瘤学结局的有利影响具有统计学意义。这种影响在局部晚期肿瘤中更为显著。倾向评分匹配分析证实了原发手术治疗对 RFS 的预后影响。
治疗策略是 p16 阴性 OPSCC 患者的独立预后因素，原发手术治疗与 OS、DSS 和 RFS 的改善相关。这些结果表明，手术策略是晚期 OPSCC 的可靠选择。
