The role of primary surgery in the treatment of advanced oropharyngeal cancer.

Background. The purpose of this study was to compare survival outcomes of patients with advanced stage oropharyngeal squamous cell carcinoma (SCC) according to surgical and nonsurgical treatments, when stratified by smoking and p16 status. Methods. We conducted a prospective longitudinal population-based study of 279 patients diagnosed with advanced oropharyngeal SCC. Patients were stratified by smoking and p16 status. Results. There was no significant disease-specific survival (DSS) difference in combined modality treatment groups in nonsmokers that had p16-positive cancers, however, in smokers with p16-positive cancers, the DSS surgery + postoperative chemoradiotherapy (S + CRT) was significantly higher than chemoradiotherapy (CRT) alone. Patients who had p16-negative cancers had the highest DSS when treated with surgery + adjuvant therapy (S + RT)/CRT. Multivariate Cox regression analysis showed that increasing Eastern Cooperative Oncology Group (ECOG) score, smoking, p16 status, higher stage, and treatment with surgery protocols were significant determinants of survival. Conclusion. Primary surgical approaches offer the best survival outcomes in smokers with p16-positive cancers and in patients with p16-negative cancers. (C) 2015 Wiley Periodicals, Inc.