Sex and survival in oropharyngeal squamous cell carcinoma: A systematic review and meta-analysis

Sex differences in cancer survival are well-established but understudied in oropharyngeal squamous cell carcinoma (OPSCC). We evaluated the impact of sex on OPSCC survival with emphasis on geographic variation. A systematic review through June 2025 identified 84 studies (N=451,136) from the United States (n=47) and non-United States cohorts (n=37). Meta-analyses assessed hazard ratios, proportions, and means. Most patients were male (80.8%; mean age 59.9years). HPV-positive OPSCC was more prevalent in the US (73.8%) than non-US countries (44.0%, P<0.0001). US males had improved overall (HR=1.13 [1.07-1.19]) and cause-specific survival (HR=1.11 [1.01-1.21]) than females. Non-US females had better OS (HR=0.86 [0.77-0.95]) and CSS (HR=0.63 [0.43-0.92]) than males. No significant differences were observed in other survival measures. Sex appears to influence OPSCC survival, with differing trends between US and non-US populations. These geographic differences likely reflect differences in HPV status. Further research stratified by sex and HPV status is needed to clarify these relationships and guide tailored interventions.