Background/Objectives:Limited metastatic squamous cell carcinoma of the oropharynx (OPC) lacks clear management guidelines, especially for HPV-associated disease. The objective of this study was to investigate if primary site radiotherapy (RT) benefits overall survival in limited metastatic OPC.Methods:Utilizing the National Cancer Database (NCDB), patients aged 18–90 with OPC presenting as cM1 with limited metastatic disease to one distant site were identified. Propensity score matching, Cox-proportional hazards models, and Kaplan–Meier estimates were employed to assess factors associated with overall survival.Results:In this study, 1056 patients were included with metastases involving bone (19.0%), brain (0.8%), lung (52.9%), liver (10.1%), and lymph nodes (20.4%). Treatment modalities included 54.6% receiving primary site RT, 45.4% receiving no RT, and 69.9% undergoing systemic therapy. For HPV-positive patients, RT (HR 0.64,p= 0.0026) and receipt of chemotherapy (HR = 0.57,p= 0.0057) were associated with improved overall survival, while bone and lung metastases were associated with decreased survival (HR = 1.75 and 1.39,p= 0.0041 and 0.041, respectively). In HPV-negative cases, survival also correlated with RT (HR = 0.65,p= 0.0047), receipt of chemotherapy (HR = 0.45,p< 0.001), clinical T4 disease (HR = 1.99,p= 0.012), presence of bone metastases (HR = 2.52,p< 0.001), lung metastases (HR = 1.49,p= 0.035), and lymphovascular invasion (HR = 1.10,p< 0.001). Overall, patients who received RT showed increased median overall survival from 9.9 to 16.1 months (p< 0.001) compared to those who did not. When stratified by RT and HPV status, there was higher median survival for both HPV-positive (from 17.1 to 24.9 months,p< 0.001) and HPV-negative patients (from 8.4 to 12.9 months,p= 0.0016) who received RT compared to those who did not.Conclusions:Primary-site radiotherapy may positively impact overall survival in limited metastatic OPC, irrespective of HPV status.
背景/目的：对于局限性转移性口咽鳞状细胞癌（OPC），目前缺乏明确的管理指南，尤其针对HPV相关疾病。本研究旨在探讨原发灶放疗（RT）是否对局限性转移性OPC患者的总生存期有益。 方法：利用美国国家癌症数据库（NCDB），筛选出年龄在18至90岁之间、临床诊断为cM1期且仅有一个远处转移部位的OPC患者。采用倾向评分匹配、Cox比例风险模型和Kaplan-Meier估计法评估与总生存期相关的因素。 结果：本研究共纳入1056例患者，转移部位包括骨（19.0%）、脑（0.8%）、肺（52.9%）、肝（10.1%）和淋巴结（20.4%）。治疗方式包括：54.6%的患者接受原发灶放疗，45.4%未接受放疗，69.9%接受全身治疗。对于HPV阳性患者，放疗（HR 0.64，p=0.0026）和接受化疗（HR=0.57，p=0.0057）与总生存期改善相关，而骨转移和肺转移则与生存期降低相关（HR分别为1.75和1.39，p值分别为0.0041和0.041）。在HPV阴性病例中，生存期同样与放疗（HR=0.65，p=0.0047）、接受化疗（HR=0.45，p<0.001）、临床T4分期（HR=1.99，p=0.012）、骨转移（HR=2.52，p<0.001）、肺转移（HR=1.49，p=0.035）以及淋巴血管侵犯（HR=1.10，p<0.001）相关。总体而言，接受放疗的患者中位总生存期从未接受放疗者的9.9个月提高至16.1个月（p<0.001）。按放疗和HPV状态分层分析显示，接受放疗的HPV阳性患者（从17.1个月增至24.9个月，p<0.001）和HPV阴性患者（从8.4个月增至12.9个月，p=0.0016）中位生存期均高于未接受放疗者。 结论：无论HPV状态如何，原发灶放疗可能对局限性转移性OPC患者的总生存期产生积极影响。
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