Transoral robotic surgery and neck dissection for HPV-positive oropharyngeal carcinoma: Importance of nodal count in survival.

Publication Title

Oral oncology

Authors

Chi T Viet, Providence Cancer Institute, Portland, OR
Eric J Dierks, Providence Cancer Institute, Portland, OR
Allen C Cheng, Providence Cancer Institute, Portland, ORFollow
Ashish Patel, Attending Head and Neck/Microvascular Surgeon, Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Portland; Consultant, Head and Neck Institute, Portland, OR.Follow
Shu-Ching Chang, Medical Data Research Center, Providence Health & Services, Portland, OR, USAFollow
Marcus Couey, Earle A. Chiles Research Institute, Providence Portland Medical Center, Portland, OR, USA; Providence Cancer Institute, Portland, OR, USAFollow
Amber L Watters, Oral Oncology, Providence Cancer Institute, Robert W. Franz Cancer Center, Portland, OregonFollow
Thien Hoang, Providence Cancer Institute, Portland, OR, United States
Hong D Xiao, Head and Neck Pathologist, Department of Pathology, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 6N50, Portland, OR 97213, USAFollow
Marka R Crittenden, Earle A. Chiles Research Institute, Robert W. Franz Cancer Center, Providence Portland Medical Center, PortlandFollow
Rom Leidner, Earle A. Chiles Research Institute, Providence Cancer InstituteFollow
Steven K Seung, Providence Cancer Institute, Portland, ORFollow
Kristina H Young, Earle A. Chiles Research Institute, Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, United States of AmericaFollow
Richard Bryan Bell, Earle A. Chiles Research Institute, Providence Cancer InstituteFollow

Document Type

Article

Publication Date

6-26-2020

Abstract

BACKGROUND: In this study we determine the survival in patients with HPV-positive oropharyngeal carcinoma treated with transoral robotic surgery (TORS), neck dissection and risk-adapted adjuvant therapy.

METHODS: We retrospectively identified 122 patients with HPV-positive oropharyngeal carcinoma treated with TORS and neck dissection between 2011 and 2018. Survival probability was calculated. We determined the effect of the type of neck dissection performed (modified radical neck dissection-MRND vs. selective neck dissection - SND), extranodal extension (ENE), margin status, and presence of ≥ 5 metastatic nodes on survival.

RESULTS: Our patient population had a five-year overall survival of 91.0% (95% C.I. 85-97%). The five-year probability of recurrence or cancer-associated death was 0.0977 (95% C.I. 0.0927-0.1027). The five-year probability of cancer-associated death was 0.0528 (95% C.I. 0.048-0.0570). All patients who died of their disease had distant metastasis. Our PEG dependence rate was 0%. Patients with ENE and positive margins who underwent adjuvant chemoradiation did not have worse survival. Presence of ≥ 5 metastatic nodes portended worse survival after controlling for age, positive ENE and margins. Low yield (<18 >nodes) on neck dissection worsened DFS on multivariable analysis. Furthermore, patients who underwent SND did not have worse OS than those who underwent MRND.

CONCLUSION: Our study demonstrates that surgery could be simplified by performing TORS with SND rather than MRND. The one true poor prognostic factor in HPV-positive oropharyngeal carcinoma patients who undergo surgery is high nodal burden. Patients with high nodal burden are much more likely to die from their disease.

Clinical Institute

Cancer

Specialty/Research Institute

Earle A. Chiles Research Institute

Specialty/Research Institute

Surgery

Specialty/Research Institute

Oncology