Primary treatment for oropharyngeal squamous cell carcinoma in Alberta, Canada: A population-based study

Background: The incidence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (SCC) is increasing and has better survival than non-HPV related oropharyngeal SCC. This study compared surgical to nonsurgical treatments and demographic, clinical, and survival differences in patients with oropharyngeal SCC, stratified by p16 status. Methods: We assembled a cohort of adult patients with oropharyngeal SCC diagnosed between 2000 and 2008 in Alberta. The tumor p16 biomarker was measured using fluorescent immunohistochemistry. Results: In this cohort, p16 data were available for 115 of 357 patients; and 66% (n576) were p16-positive. Patients with p16 data had comparable outcomes to those without. Surgically treated p16-negative patients had improved 5-year disease-specific survival (DSS) and overall survival (OS) compared with nonsurgical patients. There were no differences in survival outcomes between surgical and nonsurgical treatment for patients with p16-positive disease. Conclusion: Patients with p16-positive oropharyngeal SCC had similar outcomes regardless of treatment. Patients with p16-negative tumors may benefit from primary surgery with postoperative adjuvant therapy.