Sex-based differences in outcomes among surgically treated patients with HPV-related oropharyngeal squamous cell carcinoma

Justin R. Shinn, Ryan M. Carey, Leila J. Mady, David Shimunov, Harman S. Parhar, Steven B. Cannady, Karthik Rajasekaran, John N. Lukens, Alexander Lin, Samuel Swisher-McClure, Roger B. Cohen, Joshua M. Bauml, Christopher H. Rassekh, Jason G. Newman, Ara A. Chalian, Devraj Basu, Gregory S. Weinstein, Robert M. Brody

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objectives: Sex differences in surgically treated HPV-associated oropharyngeal squamous cell carcinoma are not defined due to the low number of affected women. We explored the oncologic outcomes of men and women with p16-positive oropharyngeal squamous cell carinoma treated with primary surgery. Materials and Methods: Retrospective analysis of patients with HPV-related oropharyngeal cancer treated with surgery and pathology guided adjuvant therapy from 2007 to 2017. Primary end point was recurrence-free and overall survival. Results: Of 468 men (86.7%) and 72 women (13.3%), women presented more often with clinical N0 nodal disease (25% vs 12.2%). There were no differences in adverse pathologic features or T stage, although women were more likely to present with N0 disease (16.7% vs 10%), less N2 disease (6.9% vs 17.7%, p = 0.03), and more stage I disease (88.9% vs 75%). As a result, women were more likely to undergo surgery alone (30.6% vs 14.1%) while men were more likely to require adjuvant radiation therapy (47.2% vs 36.1%). Four women (5.6%) and 30 men (6.4%, p = 0.8) died during follow-up. Multivariate analysis controlling for age, sex, treatment, and pathologic stage demonstrated no differences in overall survival between men and women. There were no differences in recurrence-free or overall survival between men and women at two and five years. Conclusions: Although women undergoing transoral robotic surgery for HPV+ oropharyngeal squamous cell carcinoma may have less advanced disease, upfront surgery with pathology-guided adjuvant therapy produces similar oncologic results in men and women while accounting for disease burden.

Original languageEnglish (US)
Article number105570
JournalOral Oncology
StatePublished - Dec 2021
Externally publishedYes


  • Gender
  • HPV
  • Human papillomavirus
  • Oropharyngeal cancer
  • Outcomes
  • P16
  • Robotic surgery
  • Sex

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research


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