Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
Oral Oncol. 2021 Dec;123:105570. doi: 10.1016/j.oraloncology.2021.105570. Epub 2021 Oct 29.
Sex differences in surgically treated HPV-associated oropharyngeal squamous cell carcinoma are not defined due to the low number of affected women. We explored the oncologic outcomes of men and women with p16-positive oropharyngeal squamous cell carinoma treated with primary surgery.
Retrospective analysis of patients with HPV-related oropharyngeal cancer treated with surgery and pathology guided adjuvant therapy from 2007 to 2017. Primary end point was recurrence-free and overall survival.
Of 468 men (86.7%) and 72 women (13.3%), women presented more often with clinical N0 nodal disease (25% vs 12.2%). There were no differences in adverse pathologic features or T stage, although women were more likely to present with N0 disease (16.7% vs 10%), less N2 disease (6.9% vs 17.7%, p = 0.03), and more stage I disease (88.9% vs 75%). As a result, women were more likely to undergo surgery alone (30.6% vs 14.1%) while men were more likely to require adjuvant radiation therapy (47.2% vs 36.1%). Four women (5.6%) and 30 men (6.4%, p = 0.8) died during follow-up. Multivariate analysis controlling for age, sex, treatment, and pathologic stage demonstrated no differences in overall survival between men and women. There were no differences in recurrence-free or overall survival between men and women at two and five years.
Although women undergoing transoral robotic surgery for HPV+ oropharyngeal squamous cell carcinoma may have less advanced disease, upfront surgery with pathology-guided adjuvant therapy produces similar oncologic results in men and women while accounting for disease burden.
由于受影响女性数量较少，因此 HPV 相关口咽鳞状细胞癌的手术治疗中性别差异尚未明确。我们探讨了接受以手术为主的辅助治疗的 p16 阳性口咽鳞状细胞癌男性和女性患者的肿瘤学结局。
回顾性分析了 2007 年至 2017 年间接受手术和病理指导辅助治疗的 HPV 相关口咽癌患者。主要终点为无复发生存和总体生存。
468 例男性（86.7%）和 72 例女性（13.3%）中，女性更常出现临床 N0 淋巴结疾病（25%比 12.2%）。两组在不良病理特征或 T 分期方面无差异，尽管女性更有可能出现 N0 疾病（16.7%比 10%）、较少的 N2 疾病（6.9%比 17.7%，p=0.03）和更多的 I 期疾病（88.9%比 75%）。因此，女性更可能单独接受手术（30.6%比 14.1%），而男性更可能需要辅助放疗（47.2%比 36.1%）。随访期间，有 4 名女性（5.6%）和 30 名男性（6.4%，p=0.8）死亡。多变量分析控制年龄、性别、治疗和病理分期后，男性和女性的总体生存率无差异。男性和女性在两年和五年时的无复发生存率和总体生存率均无差异。
尽管接受经口机器人手术治疗 HPV+口咽鳞状细胞癌的女性可能疾病程度较轻，但考虑到疾病负担，以手术为主并辅以病理指导的辅助治疗可在男性和女性中产生相似的肿瘤学结果。
