Association of adjuvant radiation and survival in human papilloma virus‐positive oropharynx squamous cell carcinoma with lymphovascular invasion as the sole adverse pathologic feature

Background Postoperative radiotherapy radiation therapy (PORT) for early‐stage human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (OPSCC) with positive lymphovascular invasion (LVI) has an unclear association with overall survival (OS). Methods This retrospective cohort study queried the National Cancer Database for surgically treated, T1‐2, N0‐1 HPV+ OPSCC from 2010 to 2019. Primary exposures were LVI and PORT, and the main outcome was 5‐year OS. Odds ratios and hazard ratios (HR) with 95% confidence intervals (CIs) were generated using multivariable models and Cox proportional hazard models, respectively. Results Of 2768 patients, average age was 59.3 years, 2207 (79.7%) were male, and 386 (13.9%) had LVI. Of patients with LVI as their sole adverse pathologic feature, 220 (57.0%) received PORT, which was not associated with 5‐year OS (HR, 1.13; CI, 0.65–1.19). Conclusions Patients with surgically treated, early‐stage HPV+ OPSCC and positive LVI as their only pathologic adverse feature may not require PORT.