Festa Bianca Maria, Schaefer Nancy, Reschly William, Mendenhall William M, Conrad Dustin, Hanubal Krishna, Shama Mohamed, Dirain Carolyn O, Hughley Brian, Danan Deepa, Dziegielewski Peter T
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, (MI), Italy.
Health Science Center Libraries, University of Florida, Gainesville, FL, USA.
Eur J Surg Oncol. 2025 Jul;51(7):109739. doi: 10.1016/j.ejso.2025.109739. Epub 2025 Mar 3.
This study investigated differences in survival for p16/HPV-negative OPSCC patients treated with primary surgery versus primary (chemo-)radiation therapy (CRT).
PubMed, CINAHL and Web of Science databases and the online Cochrane Library were searched for relevant English language studies describing the survival outcomes of p16/HPV-negative OPSCC patients treated with primary surgery or primary CRT. The primary endpoint was the 5-year OS; the secondary endpoints included 5-year DSS and DFS, and 3- and 2-year OS, DSS and DFS. The pooled survival curves were estimated using a distribution-free approach assuming random effects. Cumulative KM curves for OS, DSS and DFS were built for each treatment group.
Twenty-two publications were included in the final analysis. Patients included (n = 1903) were divided according to treatment ("surgery" group, n = 942; "RT/CRT" group, n = 961). For all the endpoints, surgery demonstrated improved short- and long-term survival compared to RT/CRT, although selection bias may have impacted the outcomes. The estimated pooled 5-year OS for the surgery and the RT/CRT group was 54.1 % (95 % CI: 44.4%-65.9 %) and 45.7 % (95 % CI: 41.8%-49.9 %), respectively.
Primary surgery and primary CRT for p16/HPV-negative OPSCC both provide acceptable survival outcomes, although in many cases surgery has shown improved survival rates. Further research should focus on when each treatment modality should be used to achieve the goals of treatment completion, survival and functional outcomes.
本研究调查了接受原发手术与原发（化疗）放疗（CRT）治疗的p16/HPV阴性口咽鳞状细胞癌（OPSCC）患者的生存差异。
检索了PubMed、CINAHL和Web of Science数据库以及在线Cochrane图书馆，以查找描述接受原发手术或原发CRT治疗的p16/HPV阴性OPSCC患者生存结果的相关英文研究。主要终点是5年总生存率（OS）；次要终点包括5年无病生存率（DSS）和无进展生存率（DFS），以及3年和2年的OS、DSS和DFS。采用非参数方法并假设随机效应估计合并生存曲线。为每个治疗组构建OS、DSS和DFS的累积Kaplan-Meier（KM）曲线。
最终分析纳入了22篇出版物。纳入的患者（n = 1903）根据治疗方式分为两组（“手术”组，n = 942；“放疗/CRT”组，n = 961）。对于所有终点，与放疗/CRT相比，手术显示出短期和长期生存率的改善，尽管选择偏倚可能影响了结果。手术组和放疗/CRT组估计的合并5年OS分别为54.1%（95%CI：44.4%-65.9%）和45.7%（95%CI：41.8%-49.9%）。
对于p16/HPV阴性OPSCC，原发手术和原发CRT均能提供可接受的生存结果，尽管在许多情况下手术显示出更高的生存率。进一步的研究应聚焦于何时应使用每种治疗方式以实现治疗完成、生存和功能结果的目标。
