Transoral Surgery in HPV-Positive Oropharyngeal Carcinoma: Oncologic Outcomes in the Veterans Affairs System

Farhoud Faraji; Abhishek Kumar; Rohith Voora; Shady I Soliman; Daniel Cherry; P Travis Courtney; Andrey Finegersh; Theresa Guo; Ezra Cohen; Joseph A Califano 3rd; Loren Mell; Brent Rose; Ryan K Orosco

doi:10.1002/lary.30784

Transoral Surgery in HPV-Positive Oropharyngeal Carcinoma: Oncologic Outcomes in the Veterans Affairs System

Laryngoscope. 2024 Jan;134(1):207-214. doi: 10.1002/lary.30784. Epub 2023 May 31.

Authors

Farhoud Faraji^{1

2}, Abhishek Kumar^{3

4}, Rohith Voora¹, Shady I Soliman¹, Daniel Cherry³, P Travis Courtney³, Andrey Finegersh^{1

5}, Theresa Guo^{1

2}, Ezra Cohen^{2

6}, Joseph A Califano 3rd^{1

2}, Loren Mell^{2

3}, Brent Rose^{2

3}, Ryan K Orosco⁷

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of California San Diego Health, San Diego, California, USA.
² Moores Cancer Center, University of California San Diego Health, La Jolla, California, USA.
³ Department of Radiation Medicine and Applied Sciences, University of California San Diego Health, La Jolla, California, USA.
⁴ Department of Radiation Oncology, Duke University, Durham, North Carolina, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA.
⁶ Department of Medical Oncology, University of California, San Diego, California, USA.
⁷ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico, Albuquerque, New Mexico, USA.

PMID: 37255050
PMCID: PMC10687307 (available on 2025-01-01)
DOI: 10.1002/lary.30784

Abstract

Objectives: Most transoral robotic surgery (TORS) literature for HPV-positive oropharyngeal squamous cell carcinoma (HPV-OPC) derives from high-volume tertiary-care centers. This study aims to describe long-term recurrence and survival outcomes among Veterans Health Administration patients.

Materials and methods: Using the US Veterans Affairs database, we identified patients with HPV-OPC treated with TORS between January 2010 and December 2016. Patients were stratified in risk categories: low (0-1 metastatic nodes, negative margins), intermediate (close margins, 2-4 metastatic nodes, lymphovascular or perineural invasion, pT3-pT4 tumor), or high (positive margins, extranodal extension (ENE), and/or ≥5 metastatic nodes). Primary outcomes included overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS).

Results: The cohort included 161 patients of which 29 (18%) were low-risk, 45 (28%) intermediate-risk, and 87 (54%) high-risk. ENE was present in 41% of node-positive cases and 24% had positive margins. Median follow-up was 5.6 years (95% CI, 3.0-9.3). The 5-year DSS for low, intermediate, and high-risk groups were: 100%, 90.0% (95% CI, 75.4-96.1%), and 88.7% (95% CI, 78.3-94.2%). Pathologic features associated with poor DSS on univariable analysis included pT3-T4 tumors (HR 3.81, 95% CI, 1.31-11; p = 0.01), ≥5 metastatic nodes (HR 3.41, 95% CI, 1.20-11; p = 0.02), and ENE (HR 3.53, 95% CI, 1.06-12; p = 0.04). Higher 5-year cumulative incidences of recurrence were observed in more advanced tumors (pT3-T4, 33% [95% CI, 14-54%] versus pT1-T2, 13% [95% CI, 8-19%]; p = 0.01).

Conclusions: In this nationwide study, patients with HPV-OPC treated with TORS followed by adjuvant therapy at Veterans Affairs Medical Centers demonstrated favorable survival outcomes comparable to those reported in high-volume academic centers and clinical trials.

Level of evidence: 4 Laryngoscope, 134:207-214, 2024.

Keywords: HPV; oncologic outcomes; oropharyngeal carcinoma; transoral surgery.

MeSH terms

Carcinoma, Squamous Cell* / pathology
Head and Neck Neoplasms* / etiology
Humans
Oropharyngeal Neoplasms* / pathology
Papillomavirus Infections*
Retrospective Studies
Robotic Surgical Procedures* / adverse effects
Squamous Cell Carcinoma of Head and Neck
Veterans*

Abstract

MeSH terms

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