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

Journal of the National Cancer Institute Pub Date : 2024-09-09 DOI:10.1093/jnci/djae220

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

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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.

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在社区癌症中心接受与人乳头瘤病毒相关的口咽癌手术治疗的生存率较低

背景最近，人乳头瘤病毒相关口咽癌（HPVOPC）的初级手术率有所下降，而社区癌症中心（CCs）对经口机器人手术（TORS）的使用却滞后。我们假设，在社区癌症中心和低TORS使用率（<15 TORS/年；LVACs）和高TORS使用率（≥15 TORS/年；HVACS）学术中心接受HPVOPC手术的患者之间存在总生存率（OS）差异。方法纳入美国国家癌症数据库中 2010-2019 年期间诊断为 HPVOPC 并接受初级手术治疗的病例。比较了CC、LVAC和HVAC之间的TORS使用趋势、手术切缘阳性率（PMs）、辅助治疗质量和5年OS。结果 5406 个病例符合研究标准。CC使用TORS的病例比例明显低于LVAC或HVAC（分别为26.2% vs 44.0% vs 73.9%，p&p;lt; .001）。CC的PM率明显高于LVAC或HVAC（分别为25.7% vs 15.3% vs 9.2%，p< .001）。与LVACs或HVACs相比，在CC接受辅助放疗（RT）的病例中，接受延长疗程（23.6% vs 13.1% vs 8.8%，p p &;lt;.001）或超剂量（16.5% vs 11.5% vs 8.7%，p p &;lt;.001）放疗的比例更高。CC的5年OS最低（85.2%，95%CI：81.7-88.2%），LVAC居中（88.9%，95%CI：87.2-90.4%），HVAC最高（91.4%，95%CI：89.5-92.9%；pLR<0.01）。结论根据TORS的数量，不同类型的医疗机构在HPVOPC手术和辅助治疗的类型和质量方面存在显著差异。CC的总生存率最低，LVAC居中，HVAC最高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Journal of the National Cancer Institute

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