Lower survival for surgical treatment of HPV-related oropharynx cancer at community cancer centers

Danielle R Trakimas; Wojciech K Mydlarz; Leila J Mady; Christine G Gourin; Wayne Koch; Nyall R London Jr; Harry Quon; Ana P Kiess; Tanguy Y Seiwert; Carole Fakhry

doi:10.1093/jnci/djae220

Lower survival for surgical treatment of HPV-related oropharynx cancer at community cancer centers

J Natl Cancer Inst. 2024 Sep 9:djae220. doi: 10.1093/jnci/djae220. Online ahead of print.

Authors

Danielle R Trakimas¹, Wojciech K Mydlarz^{1

2}, Leila J Mady¹, Christine G Gourin¹, Wayne Koch¹, Nyall R London Jr¹, Harry Quon^{1

3}, Ana P Kiess^{1

3}, Tanguy Y Seiwert^{1

2}, Carole Fakhry^{1

2}

Affiliations

¹ Dept of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
² Dept of Oncology, Johns Hopkins Hospital, Baltimore, MD, USA.
³ Dept of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD, USA.

PMID: 39250754
DOI: 10.1093/jnci/djae220

Abstract

Background: The rate of primary surgery for human papillomavirus-related oropharynx cancer (HPVOPC) has recently declined, while utilization of transoral robotic surgery (TORS) has lagged at community cancer centers (CCs). We hypothesize that differences in overall survival (OS) exist between patients undergoing surgery for HPVOPC at CCs and low (<15 TORS/year; LVACs) and high (≥15 TORS/year; HVACS) TORS volume academic centers.

Methods: Cases from the US National Cancer Database with a diagnosis of HPVOPC from 2010-2019 that underwent primary surgical treatment were included. Trends in TORS utilization, rates of positive surgical margins (PMs), quality of adjuvant treatment and 5-year OS were compared between CCs, LVACs and HVACs.

Results: 5,406 cases met study criteria. A significantly lower proportion of cases at CCs utilized TORS than at LVACs or HVACs (26.2% vs 44.0% vs 73.9%, respectively, p < .001). The rate of PMs was significantly higher at CCs than at LVACs or HVACs (25.7% vs 15.3% vs 9.2%, p < .001). A greater proportion of cases undergoing adjuvant radiotherapy (RT) received prolonged courses (23.6% vs 13.1% vs 8.8%, p < .001) or excessive doses (16.5% vs 11.5% vs 8.7%, p < .001) of RT at CCs than at LVACs or HVACs, respectively. 5-year OS was lowest at CCs (85.2%, 95%CI: 81.7-88.2%), intermediate at LVACs (88.9%, 95%CI: 87.2-90.4%), and highest at HVACs (91.4%, 95%CI: 89.5-92.9%; pLR<0.01).

Conclusions: Significant differences in the type and quality of surgical and adjuvant treatment for HPVOPC exist between facility types based on TORS volume. Overall survival was lowest at CCs, intermediate at LVACs and highest at HVACs.