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

Abstract

ObjectivesMost 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 MethodsUsing 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).ResultsThe 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).ConclusionsIn 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 Evidence4 Laryngoscope, 2023

Consideration of liquid biomarkers for surveillance of HPV-related oropharyngeal cancer in veteran populations

“…Saxena et al [42] 2022 5,624 vets with HPV-related cancers within the VA CDW Disproportionate hospitalizations and healthcare costs for vets with HPV-related OPSCC compared to matched controls Shay et al [43] 2015 69 vets with HPV-related OPSCC within the VA Greater Los Angeles System Higher rate of T4 and N3 tumors in vets with possible survival detriment Shires et al [44] 2023 66 vets with HPV-related OPSCC treated at VA Memphis System Lower rate of HPV-related vs HPV-negative OPSCC in single center VA population with more advanced stage Zevallos et al [45] 2016 158 vets with HPV-related OPSCC treated at Michael E. DeBakey VA, Houston No racial disparities in HPV-related OPSCC recurrence and survival outcomes…”