Oncologic Outcomes of Transoral Robotic Surgery in HPV-Associated OPSCC: A Systematic Review and Meta-Analysis.

Abstract

To define survival and recurrence outcomes of HPV associated oropharyngeal squamous cell carcinoma (OPSCC) following transoral robotic surgery (TORS). PubMed, Scopus, CINAHL. A systematic review and meta-analysis were performed on studies employing TORS in HPV-associated OPSCC. Meta-analysis of continuous measures, proportions, and comparison of weighted proportion and relative risk were performed for patient characteristics and outcomes. A total of 58 studies, comprising 16,129 adults treated with TORS for OPSCC, were included. The mean age was 59.5 years (SD 2.08) (range 18-93), with an average follow-up of 43.4 months (SD 13.36); 83.5% of the cohort was male, and 85.6% had HPV-positive OPSCC. In the HPV-positive group, TORS survival rates were 91.0% at 1 year, 94.9% at 3 years, and 89.8% at 5 years. In comparison, the HPV-negative group had survival rates of 92.3%, 84.2%, and 72.9%, respectively. Significant survival differences were observed between cohorts at 3 and 5 years (P < .0001). The HPV-positive group had a significantly higher likelihood of 5-year overall survival compared to the HPV-negative group (RR = 1.18, 95% CI: 1.05-1.34) Recurrence rates in HPV-positive patients were 2.0% local, 3.1% regional, and 5.3% locoregional, whereas HPV-negative patients had recurrence rates of 7.6% local, 6.0% regional, and 9.1% locoregional (P = .0037, .2143, .426, respectively). Distant metastasis rates were 5.6% in HPV-positive and 10.2% in HPV-negative patients (P = .0033). The higher survival rates and lower recurrences in HPV-positive OPSCC patients compared to their HPV-negative counterparts reflects the favorable long-term oncologic outcome seen in HPV-associated OPSCC.