Treatment outcomes in patients with p16-negative oropharyngeal cancer: a comparison of initial surgery and definitive chemoradiotherapy

Background p16-negative oropharyngeal squamous cell carcinoma (OPSCC) has a poorer prognosis than p16-positive disease, but evidence on optimal treatment and salvage-related morbidity remains limited.Aims and Objectives To compare outcomes of initial surgery-based treatment and definitive concurrent chemoradiotherapy (CCRT) in p16-negative OPSCC.Materials and Methods We retrospectively analyzed 103 patients with p16-negative OPSCC (2008–2020). Patients underwent surgery with or without adjuvant radiotherapy/chemoradiotherapy, or definitive CCRT. Clinical characteristics, oncologic outcomes, recurrence patterns, and complications were compared. Multivariable Cox models assessed recurrence-free and overall survival.Results Age, sex, smoking status, and subsite did not differ significantly between groups, whereas T (p = 0.004) and N (p < 0.001) categories were lower in the surgery group. Recurrence and death rates (32.3% and 11.3% vs. 39.0% and 12.2%) and salvage survival did not differ significantly. Wound complications after salvage treatment were more frequent in the CCRT group (5/16, 31.2%) than in the surgery group (1/20, 5.0%; difference 26.3%, 95% CI 1.0–50.9%; p = 0.069).Conclusions and Significance Surgery-based and CCRT-based treatments achieved similar oncologic outcomes, but initial CCRT was associated with more wound complications after salvage treatment.