A benchmark for oncologic outcomes and model for lethal recurrence risk after transoral robotic resection of HPV-related oropharyngeal cancers

Robert M Brody; David Shimunov; Roger B Cohen; Alexander Lin; John N Lukens; Lee Hartner; Charu Aggarwal; Umamaheswar Duvvuri; Kathleen T Montone; Jalal B Jalaly; Virginia A LiVolsi; Ryan M Carey; Rabie M Shanti; Karthik Rajasekaran; Ara A Chalian; Christopher H Rassekh; Steven B Cannady; Jason G Newman; Bert W O'Malley; Gregory S Weinstein; Phyllis A Gimotty; Devraj Basu

doi:10.1016/j.oraloncology.2022.105798

A benchmark for oncologic outcomes and model for lethal recurrence risk after transoral robotic resection of HPV-related oropharyngeal cancers

Oral Oncol. 2022 Apr:127:105798. doi: 10.1016/j.oraloncology.2022.105798. Epub 2022 Mar 1.

Authors

Robert M Brody¹, David Shimunov², Roger B Cohen³, Alexander Lin⁴, John N Lukens⁵, Lee Hartner⁶, Charu Aggarwal⁷, Umamaheswar Duvvuri⁸, Kathleen T Montone⁹, Jalal B Jalaly¹⁰, Virginia A LiVolsi¹¹, Ryan M Carey¹², Rabie M Shanti¹³, Karthik Rajasekaran¹⁴, Ara A Chalian¹⁵, Christopher H Rassekh¹⁶, Steven B Cannady¹⁷, Jason G Newman¹⁸, Bert W O'Malley¹⁹, Gregory S Weinstein²⁰, Phyllis A Gimotty²¹, Devraj Basu²²

Affiliations

¹ Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States; Department of Biostatistics Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Robert.Brody2@pennmedicine.upenn.edu.
² Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: David.Shimunov@pennmedicine.upenn.edu.
³ Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Roger.Cohen@pennmedicine.upenn.edu.
⁴ Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Alexander.Lin2@pennmedicine.upenn.edu.
⁵ Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: John.Lukens@pennmedicine.upenn.edu.
⁶ Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: lee.hartner@pennmedicine.upenn.edu.
⁷ Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: charu.aggarwal@pennmedicine.upenn.edu.
⁸ Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, United States. Electronic address: duvvuriu@upmc.edu.
⁹ Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: kathleen.montone@pennmedicine.upenn.edu.
¹⁰ Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: jalal.jalaly@pennmedicine.upenn.edu.
¹¹ Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: linus@pennmedicine.upenn.edu.
¹² Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Ryan.Carey@pennmedicine.upenn.edu.
¹³ Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: rabie.shanti@pennmedicine.upenn.edu.
¹⁴ Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Karthik.Rajasekaran@pennmedicine.upenn.edu.
¹⁵ Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Ara.Chalian@pennmedicine.upenn.edu.
¹⁶ Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Christopher.Rassekh@pennmedicine.upenn.edu.
¹⁷ Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Steven.Cannady@pennmedicine.upenn.edu.
¹⁸ Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Jason.Newman@pennmedicine.upenn.edu.
¹⁹ Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: bert.omalley@umm.edu.
²⁰ Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Gregory.Weinstein@uphs.upenn.edu.
²¹ Department of Biostatistics Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: pgimotty@pennmedicine.upenn.edu.
²² Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: devraj.basu@uphs.upenn.edu.

Abstract

Objectives: Increasing use of transoral robotic surgery (TORS) is likely to impact outcomes for HPV+ oropharyngeal squamous cell carcinomas (OPSCCs). We aimed to describe oncologic outcomes for a large HPV+ OPSCC cohort after TORS and develop a risk prediction model for recurrence under this treatment paradigm.

Materials and methods: 634 HPV+ OPSCC patients receiving TORS-based therapy at a single institution were reviewed retrospectively to describe survival across the entire cohort and for patients suffering recurrence. Risks for distant metastatic recurrence (DMR) and locoregional recurrence (LRR) were modeled using multivariate logistic regression analyses of case-control sub-cohorts.

Results: 5-year overall and recurrence-free survival were 91.2% and 86.1%, respectively. 5-year overall survival was 52.5% following DMR and 83.3% after isolated LRR (P = .01). In case-control analyses, positive surgical margins were associated with DMR (adjusted OR 5.8, CI 2.1-16.0, P = .001), but not isolated LRR, and increased DMR risk 4.2 fold in patients with early clinical stage disease. By contrast, LRR was associated with not receiving recommended adjuvant therapy (OR 13.4, CI 6.3-28.5, P < .001).

Conclusions: This study sets a benchmark for oncologic outcomes from HPV+ OPSCC after TORS-based therapy. Under this treatment paradigm, margins are relevant for assessing lethal recurrence risk during clinical trial design and post-treatment surveillance.

Keywords: Distant metastasis; HPV; Head and Neck cancer; Head and neck squamous cell carcinoma; Oropharyngeal cancer; TORS.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Benchmarking
Head and Neck Neoplasms* / etiology
Humans
Neoplasm Recurrence, Local / epidemiology
Oropharyngeal Neoplasms* / pathology
Papillomavirus Infections*
Retrospective Studies
Robotic Surgical Procedures* / adverse effects

Grants and funding

R01 DE027185/DE/NIDCR NIH HHS/United States