Primary treatment modalities and p16 status in oropharyngeal squamous cell carcinoma outcomes: a tertiary center...

The optimal treatment for oropharyngeal squamous cell carcinoma (OPSCC) remains undetermined. The choice between primary surgery with risk-adapted adjuvant (chemo)radiotherapy and primary (chemo)radiotherapy is left to therapeutic teams and patients. We compared survival outcomes between these approaches in large cohort stratified by p16 status.

Nonmetastatic OPSCC patients diagnosed between 2007 and 2021, with determined p16 status and treated with curative primary surgery or primary (chemo)radiotherapy, were retrospectively reviewed. Univariate, multivariate, and propensity score matching analyses were performed to compare progression-free survival (PFS) and overall survival (OS).

Of 696 identified patients, 642 met the inclusion criteria: 329 patients (51.3 %) underwent primary surgery and 313 (48.7 %) received primary (chemo)radiotherapy. p16 positivity was confirmed in 34 % and 38 % of patients, respectively. In the unmatched cohort, upfront surgery was associated with superior PFS and OS in the p16-negative group, but not in the p16-positive group. After propensity score matching, no survival advantage was observed for either treatment scenario in the p16-negative group (surgery vs. non-surgery, 5-year PFS: 52 vs. 43 %, p = 0.259; OS: 54 vs. 47 %, p = 0.396) or the p16-positive group (5-year PFS: 84 vs. 84 %, p = 0.988; OS: 86 vs. 87 %, p = 0.868).

When prognostic factors are adequately balanced, primary surgery with risk-adapted adjuvant therapy and primary (chemo)radiotherapy provide similar survival outcomes in both p16-positive and p16-negative OPSCC. Treatment decisions should be based on shared decision-making, considering patient preferences, expected oncological and functional outcomes, and institutional experience.