Margin Status and Recurrence in Surgically Treated Patients With HPV+ Oropharyngeal Cancer

• Published in: The Laryngoscope Vol. 135; no. 8; p. 2777
• Main Authors: Ausburn, Madeleine, Pyne, Justin M, Day, Andrew T, Hajnas, Natalia, Moon, Dominic, Myers, Larry Leonard, Sher, David Jonathan, Truelson, John M, Tillman, Brittny, Sumer, Baran
• Format: Journal Article
• Language: English
• Published: United States 01.08.2025
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - surgery; Carcinoma, Squamous Cell - virology; Female; Follow-Up Studies; Humans; Male; Margins of Excision; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Oropharyngeal Neoplasms - mortality; Oropharyngeal Neoplasms - pathology; Oropharyngeal Neoplasms - surgery; Oropharyngeal Neoplasms - virology; Papillomaviridae; Papillomavirus Infections - complications; Progression-Free Survival; Retrospective Studies; Robotic Surgical Procedures - methods; resection margins; survival outcomes; HPV+ oropharyngeal cancer; transoral robotic surgery; oropharyngeal squamous cell carcinoma
• ISSN: 1531-4995
• DOI: 10.1002/lary.32091

The optimal margins for surgically treated human papilloma virus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) remain undefined. We evaluated the impact of surgical margins on progression-free survival (PFS) in patients with HPV+ OPSCC treated with primary transoral robotic surgery (TORS). Patients undergoing primary TORS from May 2012 to December 2021 for intermediate-risk (T1-T2, resected to clear (≥ 3 mm) or close margins (< 3 mm), and N1-N2) HPV+ OPSCC were included. Survival outcomes were reviewed, and overall and PFS at 3 years posttreatment were determined using Kaplan-Meier analysis. A total of 69 subjects met inclusion criteria. At a median follow-up of 47 months, overall survival (OS) was 100%, and the PFS was 88.9% for the entire subject group. Among subjects not receiving adjunctive radiotherapy (RT), those with close margins had an OS of 100% and a PFS of 100% (median follow-up 47 months). Subjects with clear margins had an OS probability of 100% and a PFS probability of 100% (median follow-up 47 months). In subjects undergoing TORS for HPV+ OPSCC, clear margins did not confer a significant OS or PFS survival advantage compared to those with close margins, even when adjuvant therapy was omitted.