Outcomes of Minimally Invasive Transoral Surgery in HPV-Negative Oropharyngeal Cancer

Objective: To describe the clinical predictors of survival, disease control, and functional outcomes in patients with HPV-negative oropharyngeal squamous cell carcinoma (OPSCC) who underwent primary transoral surgery (TOS). Study Design: Retrospective cohort study. Setting: The study was conducted in a high-volume, NCI-designated tertiary care setting. Methods: Patients with HPV-negative OPSCC who underwent primary definitive TOS with risk-adapted adjuvant therapy (1998-2020) were identified. The primary outcome measures were overall survival (OS) and recurrence-free survival (RFS). Secondary outcomes included postoperative gastrostomy tube (G-tube) rates, tracheostomy rates, and functional outcome swallowing scale (FOSS) scores. Results: A total of 89 patients were treated with TOS for HPV-negative OPSCC. The majority of patients presented with late-stage disease (stage III/IV, 73%); 79% with early tumor stage (T1/T2) and 71% with positive nodal disease. Three-year estimates for OS and RFS for the entire cohort were 67.2% and 63.3% respectively. Advanced tumor stage predicted worsened OS [HR 3.23, 95% CI 1.75-5.95] and RFS [HR 2.38, 95% CI 1.13-5.01] on univariable analysis. Stage III/IV disease was associated with worsened OS [HR 2.16, 95% CI 1.01-4.63], but not RFS. Thirty-two patients (36%) recurred during the follow-up period; 19 (21%) failed locoregionally, and 13 (15%) failed distantly. Five patients (6%) were G-tube dependent and 3 patients (3%) were tracheostomy dependent at 1-year. Conclusion: Transoral surgery may be considered as a primary treatment in HPV-negative OPSCC with acceptable oncologic outcomes and the potential for improved functional outcomes.