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Original Investigation |

Survival and Gastrostomy Prevalence in Patients With Oropharyngeal Cancer Treated With Transoral Robotic Surgery vs Chemoradiotherapy

Arun Sharma, MD, MS1; Sapna Patel, MD2; Fred M. Baik, MD2; Grant Mathison, MD3; Brendan H. G. Pierce, MD3; Samir S. Khariwala, MD, MS3; Bevan Yueh, MD, MPH3; Stephen M. Schwartz, MPH, PhD4,5; Eduardo Méndez, MD, MS2,6
[+] Author Affiliations
1Division of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
2Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle
3Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis
4Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, Washington
5Department of Epidemiology, University of Washington, Seattle
6Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
JAMA Otolaryngol Head Neck Surg. 2016;142(7):691-697. doi:10.1001/jamaoto.2016.1106.
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Importance  Treatment of oropharyngeal squamous cell carcinoma (OPSCC) presents unique challenges and can be associated with significant morbidity. Transoral robotic surgery (TORS) has emerged as a treatment modality for OPSCC, but data comparing outcomes between patients treated with TORS-based therapy and nonsurgical therapy are limited.

Objective  To compare survival and gastrostomy prevalence between patients with OPSCC treated with TORS-based therapy and those treated with nonsurgical therapy.

Design, Setting, and Participants  This retrospective matched-cohort study identified patients with OPSCC treated at the University of Washington and University of Minnesota tertiary care medical centers from January 1, 2005, to December 31, 2013. Each patient treated with TORS-based therapy was matched by stage with as many as 3 patients treated with nonsurgical therapy. Final follow-up was completed on April 1, 2015.

Main Outcomes and Measures  Disease-free survival, overall survival, and gastrostomy tube prevalence.

Results  One hundred twenty-seven patients met the study criteria (113 men [89.0%]; 14 women [11.0%]; median [interquartile range] age, 57 [52-63] years); 39 patients who underwent TORS were matched to 88 patients who underwent nonsurgical therapy. Compared with the nonsurgical group, more patients had p16-positive tumors in the TORS group (30 of 31 [96.8%] vs 30 of 37 [81.1%] among patients with known p16 status). No statistically significant difference in survival between treatment groups was found in multivariable analysis (disease-free survival hazard ratio, 0.22; 95% CI, 0.04-1.36; P = .10). Patients who received TORS-based therapy had lower gastrostomy tube prevalence after treatment (13 of 39 [33.3%] vs 74 of 88 [84.1%]) for a univariable relative risk of 0.43 (95% CI, 0.27-0.67; P < .001) and a multivariable relative risk of 0.43 (95% CI, 0.27-0.68; P < .001). Gastrostomy prevalence decreased by time after treatment for both groups (TORS group: 3 of 34 [9%] at 3 months to 1 of 33 [3%] at 12 months; nonsurgical group: 37 of 82 [45%] at 3 months to 7 of 66 [11%] at 12 months).

Conclusions and Relevance  Patients undergoing TORS for OPSCC have statistically indistinguishable survival but lower gastrostomy prevalence compared with patients undergoing nonsurgical therapy for stage-matched OPSCC. TORS offers promise for improved swallowing function in patients with OPSCC.

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Figure 1.
Flowchart of Retrospective Matched Cohort Study of Patients With Oropharyngeal Squamous Cell Carcinoma (OPSCC)

TORS indicates transoral robotic surgery.

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Figure 2.
Kaplan-Meier Survival Curves Showing Disease-Free and Overall Survival

Patients with oropharyngeal squamous cell carcinoma are matched by T stage and compared by treatment group. P values are calculated by univariable log-rank test. TORS indicates transoral robotic surgery.

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Figure 3.
Gastrostomy Tube Prevalence Over Time

Patients with oropharyngeal squamous cell carcinoma are matched by T stage and compared by treatment group (88 patients in the nonsurgical treatment group and 39 in the transoral robotic surgery [TORS] group). RR indicates relative risk.

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