Department of Otolaryngology - Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA.
Head Neck. 2022 Jul;44(7):1545-1553. doi: 10.1002/hed.27045. Epub 2022 Apr 1.
Surgery + adjuvant therapy was shown to have improved overall survival (OS) versus nonsurgical treatment in T1-T2N1-N2b human papillomavirus (HPV)-negative oropharyngeal cancer (OPC). Our objective was to compare OS in transoral robotic surgery (TORS) with neck dissection versus nonsurgical treatment for T1-T2N0 HPV-negative OPC.
Patients with T1-T2N0 HPV-negative OPC were identified in the National Cancer Database. OS was compared between groups: (1) TORS with neck dissection +/- adjuvant therapy, (2) primary radiotherapy (>60 Gy) +/- chemotherapy using Kaplan-Meier and multivariable Cox proportional hazards models.
There were 665 (78.4%) patients treated nonsurgically and 183 (21.6%) patients in the TORS group. Adjusting for age, comorbidity score, facility type, tumor subsite, and tumor stage, primary nonsurgical treatment was associated with worse OS (hazard ratio: 1.90, 95% CI: 1.34-2.69).
For T1-T2N0 HPV-negative OPC, TORS with neck dissection may be associated with a survival benefit over nonsurgical treatment.
手术联合辅助治疗相较于非手术治疗在 T1-T2N1-N2b 人乳头瘤病毒（HPV）阴性口咽癌（OPC）患者中显示出改善的总生存期（OS）。我们的目的是比较 T1-T2N0HPV 阴性 OPC 患者经口机器人手术（TORS）联合颈清扫术与非手术治疗的 OS。
在国家癌症数据库中确定 T1-T2N0HPV 阴性 OPC 患者。比较以下组间的 OS：（1）TORS 联合颈清扫术 +/- 辅助治疗，（2）原发放疗（>60Gy） +/- 化疗，使用 Kaplan-Meier 和多变量 Cox 比例风险模型进行比较。
有 665 例（78.4%）患者接受非手术治疗，183 例（21.6%）患者接受 TORS 治疗。调整年龄、合并症评分、医疗机构类型、肿瘤部位和肿瘤分期后，原发非手术治疗与较差的 OS 相关（风险比：1.90，95%CI：1.34-2.69）。
对于 T1-T2N0HPV 阴性 OPC，TORS 联合颈清扫术可能与非手术治疗相比具有生存获益。
