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KMID : 0361020210640070486
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Korean Journal of Otolaryngology - Head and Neck Surgery
2021 Volume.64 No. 7 p.486 ~ p.490
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The Effectiveness of Surgery-Based Treatment in Advanced Oropharyngeal Cancers
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Kim Young-Chan
Kim Hyeon-Geun
Kwak Ji-Won
Lee Ho-Young
Jung Kwang-Yoon
Baek Seung-Kuk
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Abstract
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Background and Objectives : Oropharyngeal cancers (OPCs) can be staged down to a lowerstage with p16 positivity and de-escalated therapy has been the common practice. The aim ofthis study is to evaluate the survival outcomes based on various clinical factors in advancedOPC patients.
Subjects and Method : A total of 58 OPC patients in the stage IVA based on the AmericanJoint Committee on Cancer 7th edition were treated with primary surgery or primary chemoradiationtherapy from 2010 to 2016. A survival analysis was carried out using the Kaplan-Meier method, log-rank test, and Cox proportional hazards model.
Results : The median follow-up was 39.5 months. Thirty-eight and 20 patients received surgery-based and radiation therapy (RT)-based treatments, respectively. Clinical T-stage and treatmentmethod were significant risk factors for 5-year disease-free survival (DFS) rate, and thetreatment method was the only significant risk factor for overall-survival (OS) rate. 5-year DFSrate in the surgery-based treatment and RT-based treatment was 76.1% and 36.0% (p=0.001).
On multivariate analysis, the surgery-based treatment group was associated with a significantlyreduced hazard of death [the hazard ratio (HR) for the radiation-based treatment was 6.565compared to the surgery-based treatment, p=0.002]. 5-year OS rate in the surgery-based treatmentand RT-based treatment was 91.1% and 53.4% (p=0.003), respectively. On the multivariateanalysis, the surgery-based treatment group was associated with a significantly reducedhazard of death (the HR for the radiation-based treatment was 7.544 compared to the surgerybasedtreatment, p=0.012).
Conclusion : The primary surgery-based treatment for advanced OPC showed a better survivaloutcome than the primary radiation-based treatment, irrespective of p16 positivity.
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KEYWORD
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Chemoradiotherapy, Comparative study, Oropharyngeal neoplasms, Surgery, Survival rate
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