TORS with Neck Dissection Versus Primary Non-Surgical Treatment in Stage I and II HPV-Negative Oropharyngeal Cancer

Presentation: A097
Topic: Oropharynx / HPV Related Disease
Type: Poster
Authors: Brian Morris, MD1; Craig A Bollig, MD2
Institution(s): 1Penn State College of Medicine; 2Rutgers Robert Wood Johnson Medical School


The use of advanced, minimally invasive transoral surgical techniques for oropharyngeal cancer (OPC) have been increasing for early stage (T1 and T2) disease.  Transoral robotic surgery (TORS), in particular, has become widely adopted at many centers nationally, predominantly for HPV positive OPC.  Comparatively less information is available in HPV-negative OPC.  Recently, treatment escalation with surgery + adjuvant therapy was shown to have superior survival versus primary non-surgical treatment in T1-2, N1-2b HPV-negative OPC.  However, there is a paucity of information on comparative outcomes of TORS versus non-surgical treatment in early stage tumors without clinical evidence of nodal disease.


The aim of this study was to perform a national analysis of TORS with neck dissection versus primary non-surgical treatment for T1-2 N0 HPV-negative OPC using a large national database.

Design: Retrospective analysis of patients with T1-2 N0 M0 HPV-negative OPC in the National Cancer Database (NCDB) stratified by treatment status: 1) TORS with neck dissection +/- adjuvant therapy 2) Primary Radiation Therapy (>60 Gray) +/- chemotherapy.

Main Outcome and Measure: Baseline patient variables were compared between groups using univariate tests.  Predictors of TORS were identified using logistic regression. Overall survival (OS) was compared between groups using Kaplan-Meier method with the log-rank test as well as multivariable Cox proportional hazards models to adjust for confounders.

Results: There were 848 patients remaining after exclusions, 665 (78.4%) patients in the primary non-surgical group and 183 (21.6%) patients in the TORS group.   Clinical predictors of TORS included: treatment at an academic institution (Odds Ratio [OR]: 7.72, 95% Confidence Interval [CI]: 5.00-11.93), tonsil primary site (OR: 2.70, 95% CI: 1.70-4.29), stage T1 (OR: 3.23, 95% CI: 2.20-4.72). Adjusting for age, comorbidity score, facility type, tumor subsite, and tumor stage; primary non-surgical treatment was associated with worse OS (Hazard Ratio [HR]: 1.90, 95% CI 1.34-2.69).

Conclusions and Relevance: For T1-2 N0 HPV-negative OPC, TORS with neck dissection is associated with a survival benefit over non-surgical treatment. Given the lack of available prospective data, TORS should be strongly considered for appropriate candidates.