Treatment outcomes for human papillomavirus negative oropharyngeal cancer: A meta-analysis

Current treatment guidelines for HPV-negative oropharyngeal squamous cell carcinoma (OPSCC), the predominant form of OPSCC in Asia, are largely extrapolated from the evidence available from HPV-associated OPSCC due to a paucity in the literature in terms of the best treatment option for these cancers.

Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE and clinical trial registries were searched from January 01, 2009 to June 20, 2023 for studies comparing at least two interventions [randomized (RCT)and non-randomized] performed as primary curative treatment in HPV-negative OPSCC. Random effects model was used for the meta-analysis.

Forty-seven studies could be included (randomized controlled trials: 12, 1230 participants; non-randomized cohort studies: 35, 44253 participants). The largest comparison in the non-randomized studies was between upfront surgery and non-surgical intervention [RT/concurrent chemoradiation (CRT)] with 24 studies. The outcomes in the former for overall survival (HR:0.63, 95 %C.I: 0.56, 0.71) and disease-free survival (HR:0.48, 95 %C.I: 0.30, 0.76) were found to be superior (risk of bias: "high" or "serious"). Due to the lack of reporting of treatment-related toxicity and health-related quality of life, meta-analysis could not be performed for these outcomes.

and Relevance: Upfront surgery showed superior outcomes in terms of OS and DFS compared with non-surgical modalities in HPV-negative OPSCC, but the observed differences may be due to confounding bias. Toxicity and quality of life reporting was sparse.