ArticleEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026
Influence of resection status on overall survival in p16-positive oropharyngeal carcinoma - a retrospective analysis of cancer registry data.
Article in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeHPV-associated oropharyngeal squamous cell carcinomas show better treatment response and survival than HPV-negative tumors. Immunohistochemical p16 expression is a validated surrogate for HPV association. While resection status (R0 vs. R1) is traditionally considered prognostic, its interaction with p16 status after primary surgery is unclear. This study evaluated the combined impact of p16 status and resection margins on overall survival.
methodsA retrospective analysis of the Berlin-Brandenburg cancer registry included patients with non-metastatic OPSCC treated between 2017 and 2023 by primary surgery followed by postoperative radiotherapy with or without systemic therapy. Patients were stratified into four groups: p16-/R0, p16-/R1, p16+/R0, and p16+/R1. Overall survival was assessed using Kaplan-Meier analysis and log-rank testing. Multivariable Cox regression adjusted for age, sex, pT/pN category, ECOG status, systemic therapy, and radiotherapy dose.
resultsA total of 540 patients were included (p16-/R0: 142; p16-/R1: 19; p16+/R0: 325; p16+/R1: 54). Among R0 resections, p16-positive tumors showed significantly longer survival than p16-negative tumors (multivariate HR 0.26; p < 0.001). A similar advantage for p16-positive vs. p16-negative tumors was observed in R1 resections (multivariate HR 0.35; p = 0.030). Resection status (R1 vs. R0) was not significantly associated with survival in p16-negative (HR 0.86; p = 0.706) or p16-positive tumors after multivariable adjustment (HR 1.74; p = 0.112).
conclusionp16 status was a stronger prognostic factor than resection margins. Overall survival did not differ significantly between R0 and R1 resection after multivariable adjustment. These results support further prospective testing into surgical de-escalation strategies. Just accepting an R1 margin would shift treatment burden towards intensified adjuvant therapy rather than reduce it.
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