Surgical Versus Non-Surgical Treatment of Advanced Oropharyngeal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis.

Abstract

This review aims to compare survival outcomes of surgical versus non-surgical treatment of advanced-stage OPSCC. CINAHL, Cochrane Library, PubMed, and Scopus were searched. Studies comparing the survival of patients with advanced OPSCC treated surgically (±adjuvant therapy) or non-surgically were included. Meta-analyses hazard ratio (HR) and proportions (%) were performed for the outcomes of 2-, 3-, and 5-year overall (OS), disease-free (DFS), disease-specific (DSS), and relapse-free (RFS) survival. Forty-four studies reporting on (N = 35 681) patients were included, with a mean age of 58.9. For advanced-stage disease, primary treatment with surgery and chemoradiotherapy (CRT) demonstrated the best 5-year OS, at 67.1% (95% CI 55.6-77.6). Survival outcomes favored Surgery + CRT over other primary treatment modalities. Surgical treatment with adjuvant CRT may be associated with better OS outcomes compared with non-surgical treatment. Further research is needed to determine superior treatment modalities in OPSCC subgroups, such as HPV+ tumors.