Comparison of surgical and non surgical treatment strategies for non metastatic oropharyngeal cancer using inverse probability weighting

Surgical (SS) and non-surgical strategies (NSS) are both considered as valid options in the therapeutic management of oropharyngeal squamous cell carcinoma (OPSCC) because of the absence of randomized control trial. The objective of this retrospective cohort study was to compare the efficacy of SS versus NSS on overall survival (OS) and disease-free survival (DFS) in non-metastatic OPSCC. The study included patients treated in two centers between 2012 and 2020 treated by upfront surgery in SS group and other therapies in NSS. A Cox model allowed to estimate hazard ratios and 95%CI., Weighting by the inverse probability of a propensity score was applied due to the absence of randomization. We analyzed 432 patients with a majority (71%) of male patients and a mean age of 62.6 (SD10.1), HPV prevalence of 70%, 61% were smokers. The 5-year OS and DFS were 59% (95%CI 54–64) and 61% (95% CI 56–66), respectively. The sample was split into SS (n = 254) and NSS (n = 178). Patients exposed to SS were statistically younger (p < 0.001), with a better performance status (PS) (p < 0.001), and less advanced TNM stage (p < 0.001). After weighting, the two groups were comparable. The weighted HR of SS versus NSS were 0.65 (95%CI 0.45–0.95, p = 0.02) and 0.67 (95%CI 0.47–0.94, p = 0.02) for OS and DFS respectively. Further sensitivity analysis confirmed these results. While our findings suggest potential benefits of SS, ongoing controlled randomized trials are essential to conform these observations.