The Lack of Standardized Outcomes for Surgical Salvage of HPV-Positive Recurrent Oropharyngeal Squamous Cell Carcinoma: A Systematic Scoping Review

Abstract

Although HPV status is known to provide an improved prognosis in initial treatments of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC), it is unclear how it affects patients who receive salvage surgery (SS), which has historically poor survival rates. The purpose of this study was to evaluate the role of SS for patients with locoregional recurrence (LRR) of HPV-positive OPSCC and its impact survival rates. We conducted a scoping review of literature through October 2022 and included 995 individuals. Survival endpoints, such as overall survival (OS), Kaplan–Meier curves, and median post-recurrence survival, were analyzed in addition to demographics. Of all studies, 18.8% (6/32) reported any survival data for SS patients, with the most prevalent reporting 2- and 5-year OS in two studies. Median post-recurrence survival was not reported for SS. These findings reveal the limited and unpredictable reporting of survival-specific data on SS for HPV-positive OPSCC. With limited survival assessment, it is difficult to assess the potential advantages and disadvantages of this therapy to guide clinical decision-making.

Review of Outcomes after Salvage Surgery for Recurrent Squamous Cell Carcinoma of the Head and Neck

“…Reported 3-year survival rates following salvage surgery for oropharyngeal carcinoma ranged from 34 to 62% [45,46]. In the study by Zafereo et al, twenty-six out of thirty-nine patients (67%) developed a second recurrence after salvage surgery for oropharyngeal cancer [47].…”

“…Patients with recurrent neck disease (p = 0.01) and positive surgical margins (p = 0.04) experienced higher rates of recurrence after salvage surgery. For HPV-related oropharyngeal cancer, Taniguchi et al found heterogeneity when reporting overall and disease-specific survival outcomes after salvage surgery [45]. Two-year overall survival, specifically after salvage surgery for HPV-related oropharyngeal carcinoma, was reported at 51% in one study [48] and 91% in another [49], and 5-year overall survival was reported at 27% in one study [48] and 43% in another [50].…”

Editorial: Special Issue on the Epidemiology of Human Papilloma Virus-Associated Oropharyngeal Squamous Cell Carcinoma

“…Salvage surgery exists in case of recurrent or persistent disease after initial definitive treatment [ 17 , 18 ]. Unfortunately, these patients have historically poor survival outcomes, and the impact of HPV positivity has not been well established due to a lack of reported survival characteristics in patients that undergo salvage surgery (see the article by Taniguchi in this issue) [ 19 ]. The need for future research into survival measures in these patients is needed.…”