Traditionally, advanced head and neck cancer has been managed through surgery with or without postoperative radiotherapy. Studies since the 1980s have been advocating organ preservation therapies by using various combinations of chemotherapy and radiotherapy. For treatment of advanced oropharyngeal and hypopharyngeal cancer, there has been a controversy in choosing between primary surgery and chemoradiotherapy. We aimed at conducting a propensity-score matched study from a national database to investigate the survival after primary surgery with or without postoperative radiotherapy versus chemoradiotherapy in patients with advanced oropharyngeal and hypopharyngeal cancer.
We identified patients with stage III & IVa oropharyngeal and hypopharyngeal cancers between 2004 and 2009 from Taiwan National Health Insurance Claims Database. The study cohort was followed until 2012. We matched patients who received primary surgery to those who received chemoradiotherapy by propensity score calculated by logistic regression. Age at diagnosis, Charlson comorbidity index score, year of cancer diagnosis, clinical stage, receiving chemoradiotherapy, and receiving radiation therapy were well matched in these two groups. Overall survival and disease-free survival were compared using the Kaplan–Meier method.
We identified 1,603 oropharyngeal and 1,512 hypopharyngeal cancer patients. After propensity score matching, 614 patients with oropharyngeal cancer and 638 patients with hypopharyngeal cancer were included in the analysis. For advanced hypopharyngeal cancer (stage III and IVa), the overall survival and disease-free survival in patients receiving primary surgery with or without radiotherapy were statistically better than the matched sample who received chemoradiotherapy. For oropharyngeal cancer, the survival benefit only existed in stage IVa patients who received primary surgery with or without radiotherapy.
The study showed that primary surgery with or without radiotherapy might have survival benefit in patients advanced oropharyngeal or hypopharyngeal cancer as compared to chemoradiotherapy.
Clinical trial identification
Legal entity responsible for the study
Koo Foundation Sun-yat Sen Cancer Center
Health and Welfare Surcharge of Tobacco Products grant of Taiwan
The author has declared no conflicts of interest.