Abstract：
BACKGROUND: Transoral surgical resectability (TOS) is a prognostic factor for patients with HPV+ T1-2 oropharyngeal squamous cell carcinoma (OPSCC) disease undergoing radiotherapy (RT), but it is unclear whether this holds for HPV-negative (HPV-) patients. We aimed to compare outcomes of potential TOS-candidates vs. non-TOS candidates, among patients who underwent RT/CRT for early T-stage HPV- OPSCC.
METHODS: For patients treated with RT/CRT for early T-stage HPV-negative OPSCC between 2014 and 2021, pretreatment imaging was reviewed by four head-and-neck surgeons, masked to clinical outcomes, to assess primary-site suitability for TOS. Extracapsular extension (ECE) was assessed by a head-and-neck neuroradiologist. We compared outcomes based on surgical resectability relating to: (1) the primary site tumor alone, and (2) the primary site plus the absence/presence of ECE (overall assessment). Kaplan-Meier curves for overall survival (OS), disease-specific survival (DSS), and progression-free survival (PFS) were compared using the log-rank test.
RESULTS: Seventy patients were included in the analysis. The primary site was TOS-favorable in 46/70 (66%). Based on the overall assessment, 41/70 (58.6%) were TOS-favorable. The 3-year OS, DSS and PFS for primary site TOS-favorable versus unfavorable were OS: 76.9% versus 37.4%; DSS: 78.1% versus 46.2%, PFS: 69.9% versus 41.3%, (log-rank test = 0.01, 0.03, 0.04; respectively). Additionally, patients with an overall assessment of TOS favorability demonstrated better survival outcomes compared with TOS-unfavorable patients (OS: 77.3% vs. 46.2%; DSS: 78.2% vs. 56.5%, PFS: 72.3% vs. 42.1%, log-rank test = 0.01, 0.04, 0.01; respectively).
CONCLUSIONS: Patients with TOS-favorable HPV-negative early T-stage OPSCC have superior survival outcomes than TOS-unfavorable patients.
METHODS: For patients treated with RT/CRT for early T-stage HPV-negative OPSCC between 2014 and 2021, pretreatment imaging was reviewed by four head-and-neck surgeons, masked to clinical outcomes, to assess primary-site suitability for TOS. Extracapsular extension (ECE) was assessed by a head-and-neck neuroradiologist. We compared outcomes based on surgical resectability relating to: (1) the primary site tumor alone, and (2) the primary site plus the absence/presence of ECE (overall assessment). Kaplan-Meier curves for overall survival (OS), disease-specific survival (DSS), and progression-free survival (PFS) were compared using the log-rank test.
RESULTS: Seventy patients were included in the analysis. The primary site was TOS-favorable in 46/70 (66%). Based on the overall assessment, 41/70 (58.6%) were TOS-favorable. The 3-year OS, DSS and PFS for primary site TOS-favorable versus unfavorable were OS: 76.9% versus 37.4%; DSS: 78.1% versus 46.2%, PFS: 69.9% versus 41.3%, (log-rank test = 0.01, 0.03, 0.04; respectively). Additionally, patients with an overall assessment of TOS favorability demonstrated better survival outcomes compared with TOS-unfavorable patients (OS: 77.3% vs. 46.2%; DSS: 78.2% vs. 56.5%, PFS: 72.3% vs. 42.1%, log-rank test = 0.01, 0.04, 0.01; respectively).
CONCLUSIONS: Patients with TOS-favorable HPV-negative early T-stage OPSCC have superior survival outcomes than TOS-unfavorable patients.
摘要：
背景：经口手术可切除性（TOS）是接受放射治疗（RT）的HPVT1-2口咽鳞状细胞癌（OPSCC）患者的预后因素，但目前尚不清楚这是否适用于HPV阴性（HPV-）患者。我们旨在比较潜在的TOS候选者与非TOS候选人,在接受RT/CRT治疗早期T期HPV-OPSCC的患者中。
方法：对于2014年至2021年接受RT/CRT治疗的早期T期HPV阴性OPSCC的患者，由四名头颈部外科医生回顾了预处理成像，掩盖了临床结果，评估主要站点对TOS的适用性。头颈部神经放射学家评估了囊外延伸（ECE）。我们比较了基于手术可切除性的结果：（1）仅原发部位肿瘤，和（2）主要地点加上不存在/存在ECE（总体评估）。总生存期(OS)的Kaplan-Meier曲线，疾病特异性生存率（DSS），使用对数秩检验比较无进展生存期（PFS）。
结果：70例患者被纳入分析。主要部位为46/70(66%)的TOS有利。根据总体评估，41/70（58.6%）对TOS有利。3年OS,主站点TOS有利与不利的DSS和PFS分别为OS：76.9%对37.4%；DSS：78.1%对46.2%，PFS：69.9%对41.3%，(对数秩检验=0.01,0.03,0.04;分别)。此外,与对TOS不利的患者相比，对TOS有利性进行总体评估的患者表现出更好的生存结果（OS：77.3％vs.46.2%；DSS：78.2%56.5%,PFS：72.3%vs.42.1%,对数秩检验=0.01、0.04、0.01；分别)。
结论：TOS有利的HPV阴性早期T期OPSCC患者的生存结局优于TOS不利的患者。
方法：对于2014年至2021年接受RT/CRT治疗的早期T期HPV阴性OPSCC的患者，由四名头颈部外科医生回顾了预处理成像，掩盖了临床结果，评估主要站点对TOS的适用性。头颈部神经放射学家评估了囊外延伸（ECE）。我们比较了基于手术可切除性的结果：（1）仅原发部位肿瘤，和（2）主要地点加上不存在/存在ECE（总体评估）。总生存期(OS)的Kaplan-Meier曲线，疾病特异性生存率（DSS），使用对数秩检验比较无进展生存期（PFS）。
结果：70例患者被纳入分析。主要部位为46/70(66%)的TOS有利。根据总体评估，41/70（58.6%）对TOS有利。3年OS,主站点TOS有利与不利的DSS和PFS分别为OS：76.9%对37.4%；DSS：78.1%对46.2%，PFS：69.9%对41.3%，(对数秩检验=0.01,0.03,0.04;分别)。此外,与对TOS不利的患者相比，对TOS有利性进行总体评估的患者表现出更好的生存结果（OS：77.3％vs.46.2%；DSS：78.2%56.5%,PFS：72.3%vs.42.1%,对数秩检验=0.01、0.04、0.01；分别)。
结论：TOS有利的HPV阴性早期T期OPSCC患者的生存结局优于TOS不利的患者。
