Abstract
OBJECTIVE: 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. METHOD: 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. RESULTS: 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. CONCLUSIONS: While our findings suggest potential benefits of SS, ongoing controlled randomized trials are essential to conform these observations. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12672-025-04272-7.