Surgery-based multimodal therapy outperforms chemoradiotherapy alone in HPV-negative advanced HSCC: superior outcomes...

To explore whether the Human Papillomavirus (HPV) status plays a role in the selection of treatments for hypopharyngeal squamous cell carcinoma (HSCC), we compared the survival outcomes of patients with different HPV statuses who underwent surgery combined with chemoradiotherapy and chemoradiotherapy alone.

Patient's data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM), multivariate Cox regression analysis, and Kaplan‒Meier analysis were conducted.

591 patients were obtained from the SEER database. The study revealed that HPV-positive HSCC patients had better cancer specific survival (CSS) (P = 0.009) and overall survival (OS) (P < 0.001). These findings were also supported by Multivariate Cox regression analysis. Kaplan‒Meier analysis revealed that surgery significantly improved CSS (P = 0.023) and OS (P = 0.004) in HPV-negative HSCC patients. However, for HPV-positive patients, there was no significant improvement in CSS (P = 0.565) or OS (P = 0.863). Similar results were obtained after PSM. We further analyzed that among HPV-negative patients with stage T3 disease, surgery significantly improved the 5-year OS rate (12.17% vs. 62.06%; P = 0.002) and CSS rate (25.90% vs. 68.15%; P = 0.019). For stage N2-3 HPV-negative HSCC patients, the 5-year OS and CSS of the surgery group and no surgery group were 62.31% vs. 29.76% (P = 0.011) and 65.59% vs. 44.39% (P = 0.104), respectively. However, for HPV-positive patients with different T stages and N stages, there was no significant survival difference.

Surgery combined with chemoradiotherapy is more suitable for HPV-negative patients with stage T3 and stage N2-3 disease.