Upfront surgery versus definitive radiotherapy: competing risk analyses for cancer-specific and noncancer mortality in oropharyngeal cancer
Purpose The optimal treatment strategy for oropharyngeal cancer (OPC) is undetermined. We aim to compare the survival outcomes of OPC patients treated with upfront surgery versus definitive radiotherapy (RT). Methods A total of 8057 cases were retrieved from the Surveillance, Epidemiology, and End R...
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| Veröffentlicht in: | European archives of oto-rhino-laryngology 2024-06, Vol.281 (6), p.3157-3166 |
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| creator | Peng, Liang Zhan, Guang-Ye Sun, Wei Wen, Wei-Ping Lei, Wen-Bin |
| description | Purpose
The optimal treatment strategy for oropharyngeal cancer (OPC) is undetermined. We aim to compare the survival outcomes of OPC patients treated with upfront surgery versus definitive radiotherapy (RT).
Methods
A total of 8057 cases were retrieved from the Surveillance, Epidemiology, and End Results database. Primary endpoints were cancer-specific and noncancer mortalities, which were estimated using cumulative incidence function and compared by Gray’s test. Univariate and multivariate Fine–Gray subdistribution hazard models were used to estimate the effects of treatment modality on mortality. Subgroup analyses were performed in propensity-score-matched cohorts. All the analyses were conducted separately in human papillomavirus (HPV)-negative and HPV-positive cohorts.
Results
In the HPV-negative cohort, definitive RT was independently associated with increased risk of cancer-specific mortality (adjusted subdistribution hazard ratio [SHR], 1.31; 95% confidence interval [CI], 1.05–1.64;
P
= 0.017) and noncancer mortality (adjusted SHR, 1.59; 95% CI 1.13–2.25;
P
= 0.008). In the HPV-positive cohort, definitive RT was independently associated with increased risk of cancer-specific mortality (adjusted SHR, 1.51; 95% CI 1.23–1.85;
P
|
| doi_str_mv | 10.1007/s00405-024-08578-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2972704913</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2972704913</sourcerecordid><originalsourceid>FETCH-LOGICAL-c298t-c22cef8d6c697c165496d4fda2320d04bc3959ba52004acaa7e87bb0448ced383</originalsourceid><addsrcrecordid>eNp9UcFu1TAQtBCIvhZ-gAPykUtgYztxzA1VtFSq1As9W469eXVJ7GAnlfIN_WkMeXDksivtzox2Zwh5V8PHGkB-ygACmgqYqKBrZFfBC3KoBReVkKx9SQ6guKyEkPKMnOf8CACNUPw1OeNdA1zJ-kCe7-chxbDQvKYjpo0-Ycprpg4HH_zin5Am43xcHjCZeftMbZxmXHw40uTzD2qCGbeMmQ4xUWuCxVTlGa0fvC1LR0MM-5hOMS1m9MtGfaAxxfnBpC0c0Ywn4hvyajBjxrenfkHur75-v_xW3d5d31x-ua0sU91SKrM4dK61rZK2bstPrRODM4wzcCB6y1WjetOw4o-xxkjsZN-DEJ1Fxzt-QT7sunOKP1fMi558tjiOJmBcs2ZKMglC1bxA2Q61KeaccNBz8lO5W9egf4eg9xB0CUH_CUFDIb0_6a_9hO4f5a_rBcB3QC6r4kDSj3FNxcn8P9lfZtmWqQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2972704913</pqid></control><display><type>article</type><title>Upfront surgery versus definitive radiotherapy: competing risk analyses for cancer-specific and noncancer mortality in oropharyngeal cancer</title><source>SpringerLink Journals - AutoHoldings</source><creator>Peng, Liang ; Zhan, Guang-Ye ; Sun, Wei ; Wen, Wei-Ping ; Lei, Wen-Bin</creator><creatorcontrib>Peng, Liang ; Zhan, Guang-Ye ; Sun, Wei ; Wen, Wei-Ping ; Lei, Wen-Bin</creatorcontrib><description>Purpose
The optimal treatment strategy for oropharyngeal cancer (OPC) is undetermined. We aim to compare the survival outcomes of OPC patients treated with upfront surgery versus definitive radiotherapy (RT).
Methods
A total of 8057 cases were retrieved from the Surveillance, Epidemiology, and End Results database. Primary endpoints were cancer-specific and noncancer mortalities, which were estimated using cumulative incidence function and compared by Gray’s test. Univariate and multivariate Fine–Gray subdistribution hazard models were used to estimate the effects of treatment modality on mortality. Subgroup analyses were performed in propensity-score-matched cohorts. All the analyses were conducted separately in human papillomavirus (HPV)-negative and HPV-positive cohorts.
Results
In the HPV-negative cohort, definitive RT was independently associated with increased risk of cancer-specific mortality (adjusted subdistribution hazard ratio [SHR], 1.31; 95% confidence interval [CI], 1.05–1.64;
P
= 0.017) and noncancer mortality (adjusted SHR, 1.59; 95% CI 1.13–2.25;
P
= 0.008). In the HPV-positive cohort, definitive RT was independently associated with increased risk of cancer-specific mortality (adjusted SHR, 1.51; 95% CI 1.23–1.85;
P
< 0.001) and noncancer mortality (adjusted SHR, 1.53; 95% CI 1.11–2.12;
P
= 0.009).
Conclusion
Upfront surgery is a superior treatment modality compared with definitive RT in terms of lowering cancer-specific and noncancer mortality in OPC patients, regardless of HPV status. Further prospective clinical trials are needed to confirm our findings.</description><identifier>ISSN: 0937-4477</identifier><identifier>EISSN: 1434-4726</identifier><identifier>DOI: 10.1007/s00405-024-08578-0</identifier><identifier>PMID: 38503971</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Head and Neck ; Head and Neck Surgery ; Medicine ; Medicine & Public Health ; Neurosurgery ; Otorhinolaryngology</subject><ispartof>European archives of oto-rhino-laryngology, 2024-06, Vol.281 (6), p.3157-3166</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c298t-c22cef8d6c697c165496d4fda2320d04bc3959ba52004acaa7e87bb0448ced383</cites><orcidid>0000-0002-9720-1997</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00405-024-08578-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00405-024-08578-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38503971$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Peng, Liang</creatorcontrib><creatorcontrib>Zhan, Guang-Ye</creatorcontrib><creatorcontrib>Sun, Wei</creatorcontrib><creatorcontrib>Wen, Wei-Ping</creatorcontrib><creatorcontrib>Lei, Wen-Bin</creatorcontrib><title>Upfront surgery versus definitive radiotherapy: competing risk analyses for cancer-specific and noncancer mortality in oropharyngeal cancer</title><title>European archives of oto-rhino-laryngology</title><addtitle>Eur Arch Otorhinolaryngol</addtitle><addtitle>Eur Arch Otorhinolaryngol</addtitle><description>Purpose
The optimal treatment strategy for oropharyngeal cancer (OPC) is undetermined. We aim to compare the survival outcomes of OPC patients treated with upfront surgery versus definitive radiotherapy (RT).
Methods
A total of 8057 cases were retrieved from the Surveillance, Epidemiology, and End Results database. Primary endpoints were cancer-specific and noncancer mortalities, which were estimated using cumulative incidence function and compared by Gray’s test. Univariate and multivariate Fine–Gray subdistribution hazard models were used to estimate the effects of treatment modality on mortality. Subgroup analyses were performed in propensity-score-matched cohorts. All the analyses were conducted separately in human papillomavirus (HPV)-negative and HPV-positive cohorts.
Results
In the HPV-negative cohort, definitive RT was independently associated with increased risk of cancer-specific mortality (adjusted subdistribution hazard ratio [SHR], 1.31; 95% confidence interval [CI], 1.05–1.64;
P
= 0.017) and noncancer mortality (adjusted SHR, 1.59; 95% CI 1.13–2.25;
P
= 0.008). In the HPV-positive cohort, definitive RT was independently associated with increased risk of cancer-specific mortality (adjusted SHR, 1.51; 95% CI 1.23–1.85;
P
< 0.001) and noncancer mortality (adjusted SHR, 1.53; 95% CI 1.11–2.12;
P
= 0.009).
Conclusion
Upfront surgery is a superior treatment modality compared with definitive RT in terms of lowering cancer-specific and noncancer mortality in OPC patients, regardless of HPV status. Further prospective clinical trials are needed to confirm our findings.</description><subject>Head and Neck</subject><subject>Head and Neck Surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurosurgery</subject><subject>Otorhinolaryngology</subject><issn>0937-4477</issn><issn>1434-4726</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9UcFu1TAQtBCIvhZ-gAPykUtgYztxzA1VtFSq1As9W469eXVJ7GAnlfIN_WkMeXDksivtzox2Zwh5V8PHGkB-ygACmgqYqKBrZFfBC3KoBReVkKx9SQ6guKyEkPKMnOf8CACNUPw1OeNdA1zJ-kCe7-chxbDQvKYjpo0-Ycprpg4HH_zin5Am43xcHjCZeftMbZxmXHw40uTzD2qCGbeMmQ4xUWuCxVTlGa0fvC1LR0MM-5hOMS1m9MtGfaAxxfnBpC0c0Ywn4hvyajBjxrenfkHur75-v_xW3d5d31x-ua0sU91SKrM4dK61rZK2bstPrRODM4wzcCB6y1WjetOw4o-xxkjsZN-DEJ1Fxzt-QT7sunOKP1fMi558tjiOJmBcs2ZKMglC1bxA2Q61KeaccNBz8lO5W9egf4eg9xB0CUH_CUFDIb0_6a_9hO4f5a_rBcB3QC6r4kDSj3FNxcn8P9lfZtmWqQ</recordid><startdate>20240601</startdate><enddate>20240601</enddate><creator>Peng, Liang</creator><creator>Zhan, Guang-Ye</creator><creator>Sun, Wei</creator><creator>Wen, Wei-Ping</creator><creator>Lei, Wen-Bin</creator><general>Springer Berlin Heidelberg</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9720-1997</orcidid></search><sort><creationdate>20240601</creationdate><title>Upfront surgery versus definitive radiotherapy: competing risk analyses for cancer-specific and noncancer mortality in oropharyngeal cancer</title><author>Peng, Liang ; Zhan, Guang-Ye ; Sun, Wei ; Wen, Wei-Ping ; Lei, Wen-Bin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c298t-c22cef8d6c697c165496d4fda2320d04bc3959ba52004acaa7e87bb0448ced383</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Head and Neck</topic><topic>Head and Neck Surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurosurgery</topic><topic>Otorhinolaryngology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Peng, Liang</creatorcontrib><creatorcontrib>Zhan, Guang-Ye</creatorcontrib><creatorcontrib>Sun, Wei</creatorcontrib><creatorcontrib>Wen, Wei-Ping</creatorcontrib><creatorcontrib>Lei, Wen-Bin</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European archives of oto-rhino-laryngology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Peng, Liang</au><au>Zhan, Guang-Ye</au><au>Sun, Wei</au><au>Wen, Wei-Ping</au><au>Lei, Wen-Bin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Upfront surgery versus definitive radiotherapy: competing risk analyses for cancer-specific and noncancer mortality in oropharyngeal cancer</atitle><jtitle>European archives of oto-rhino-laryngology</jtitle><stitle>Eur Arch Otorhinolaryngol</stitle><addtitle>Eur Arch Otorhinolaryngol</addtitle><date>2024-06-01</date><risdate>2024</risdate><volume>281</volume><issue>6</issue><spage>3157</spage><epage>3166</epage><pages>3157-3166</pages><issn>0937-4477</issn><eissn>1434-4726</eissn><abstract>Purpose
The optimal treatment strategy for oropharyngeal cancer (OPC) is undetermined. We aim to compare the survival outcomes of OPC patients treated with upfront surgery versus definitive radiotherapy (RT).
Methods
A total of 8057 cases were retrieved from the Surveillance, Epidemiology, and End Results database. Primary endpoints were cancer-specific and noncancer mortalities, which were estimated using cumulative incidence function and compared by Gray’s test. Univariate and multivariate Fine–Gray subdistribution hazard models were used to estimate the effects of treatment modality on mortality. Subgroup analyses were performed in propensity-score-matched cohorts. All the analyses were conducted separately in human papillomavirus (HPV)-negative and HPV-positive cohorts.
Results
In the HPV-negative cohort, definitive RT was independently associated with increased risk of cancer-specific mortality (adjusted subdistribution hazard ratio [SHR], 1.31; 95% confidence interval [CI], 1.05–1.64;
P
= 0.017) and noncancer mortality (adjusted SHR, 1.59; 95% CI 1.13–2.25;
P
= 0.008). In the HPV-positive cohort, definitive RT was independently associated with increased risk of cancer-specific mortality (adjusted SHR, 1.51; 95% CI 1.23–1.85;
P
< 0.001) and noncancer mortality (adjusted SHR, 1.53; 95% CI 1.11–2.12;
P
= 0.009).
Conclusion
Upfront surgery is a superior treatment modality compared with definitive RT in terms of lowering cancer-specific and noncancer mortality in OPC patients, regardless of HPV status. Further prospective clinical trials are needed to confirm our findings.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>38503971</pmid><doi>10.1007/s00405-024-08578-0</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-9720-1997</orcidid></addata></record> |
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| subjects | Head and Neck Head and Neck Surgery Medicine Medicine & Public Health Neurosurgery Otorhinolaryngology |
| title | Upfront surgery versus definitive radiotherapy: competing risk analyses for cancer-specific and noncancer mortality in oropharyngeal cancer |
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