Background: In recent years, it is widely acknowledged that human papillomavirus (HPV) - associated oropharyngeal squamous cell carcinomas (OPSCC) frequently show different clinical and pathological features. Many studies have reported that increased expression of p16 by immunohistochemistry is considered to be a surrogate marker of HPV-associated carcinogenesis. The carcinogenesis of p16 negative OPSCC is different from p16 positive tumor. P16-positive OPSCC has in general a better clinical outcome than HPV-negative OPSCC. The different treatment strategy would affect the clinical outcomes among patients with resectable advanced p16 negative tonsillar cancer.

Methods: A retrospective study was conducted between 1996 June and 2013 June and included 128 patients of advanced tonsillar carcinoma with negative expression of p16. 69 patients were primary surgery group and 59 patients were primary radiation group.

Results: Patients in primary surgery group had a more favorable 5-year local/regional control rate (72% vs. 44.5%, p=0.001), 5-year overall survival rate (54.2% versus 41.4%, p=0.039) and 5-year disease specific survival rate (74.8% versus 48.2%, p=0.003) compared with patients in primary radiation group.

Conclusion:: The surgical intervention could be considered as the treatment strategy among patients of p16 negative resectable advanced tonsillar cancer to achieve the better clinical outcomes.