Transoral Robotic Surgery Versus Chemoradiation Treatment in Oropharyngeal Cancer: Case-matched Comparison of Survival and Swallowing Outcomes
Bibliographic record
Abstract
Abstract Background As the incidence of HPV/p16-positve oropharyngeal squamous cell carcinoma (OPSCC) continues to rise, a large population of survivors with treatment related morbidity is emerging. Transoral robotic surgery (TORS) is an excellent surgical option for p16-positive OPSCC but data comparing both survival and swallowing outcomes of this treatment versus radiotherapy/chemoradiotherapy (RT/CRT) remains limited. Methods Data was prospectively collected (05/2014 - 02/2019) in a tertiary care referral center from OPSCC patients treated with curative intent by TORS (+/-post-operative RT/CRT) or RT/CRT. Surgical and non-surgical treatment groups were case-matched for smoking status, T-stage, and N-stage based on AJCC 8th edition staging. Patients who were treated with curative intent by TORS (+/-post-operative RT/CRT) or RT/CRT for OPSCC were included. Overall survival, recurrence free survival, aspiration free survival and gastrostomy tube outcomes were compared using univariate and multivariate statistical analyses. Results A total of 82 patients treated with TORS were case-matched with 61 patients who received RT/CRT. TORS patients demonstrated a significantly (p=0.02) higher overall survival (OS) at 3 years (OS=93.2%) compared to RT/CRT patients (OS=78.9%). No statistically significant difference was seen in recurrence free survival when comparing the two groups. TORS patients demonstrated an aspiration free survival (AFS) of 64.7% compared to 26.1% in RT/CRT patients (p=0.02 Log-Rank, 0.018 Breslow). TORS patients also had significantly (p < 0.01) lower gastrostomy tube placement (13.4%) compared to RT/CRT (22.9%) at any point during treatment. Conclusion Patients undergoing treatment by TORS may have comparable survival and improved swallowing outcomes when compared to those undergoing RT/CRT for HPV-OPSCC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".