在了解人乳头瘤病毒（HPV）与口咽癌（OP-SCC）的关联之前，就已经对初次手术治疗后局部区域复发的中危和高危特征（IRFs/HRFs）进行了定义。目前关于与HPV相关的OP-SCC患者的术后放疗（PORT）或放化疗（POCRT）的实践模式和结果的报告较少。我们查询了National Cancer Database，针对最初使用手术治疗并具有IRFs或HRFs的HPV相关的OP-SCC患者进行了分类研究。IRFs被定义为pT3/T4病也即病理分期为T3/T4，pN1-3病也即淋巴结转移为N1-3，以及恶性肿瘤对淋巴血管侵犯，而HRFs被定义为正面切缘和淋巴结外转移（ENE）。患者被分为不接受辅助治疗、PORT治疗或POCRT治疗三组。采用Kaplan-Meier分析比较各组治疗后的总生存率（OS），然后使用Cox多变量（MVA）比例风险模型和倾向性评分分析进行逆概率治疗加权（IPTW）。我们共筛选出6301名患者，其中51.2%只有IRFs，48.8%具有HRFs。关于治疗方面，有25.5%的患者未接受放疗，38.2%接受PORT，36.3%接受POCRT。未接受放疗或放化疗的IRFs患者的8年总生存率较低（81.1% vs. 87.8%; p < 0.001），在使用IPTW MVA进行分析后仍然具有显著意义（风险比（HR） = 1.69 (95% CI: 1.27-2.24; p < 0.001)）。对于具有HRFs的患者，PORT组和POCRT组的8年总生存率没有显著差异（77.3% vs. 79.2%; p = 0.22），在使用IPTW MVA进行分析后仍然没有统计学意义（HR = 0.91(0.72-1.17); p = 0.48）。有不可忽视的比例的具有IRFs或HRFs的HPV相关OP-SCC患者没有接受PORT治疗，这与较低的总生存率有关。我们没有具备统计力量表明在具有HRFs的患者中，POCRT与PORT相比可以提高总生存率，不过还是需要进行前瞻性研究。版权所有 © 2023 Elsevier Ltd. All rights reserved.

Intermediate and high-risk features (IRFs/HRFs) for locoregional recurrence following initial surgery for oropharyngeal SCCs (OP-SCCs) were defined prior to the known association of HPV with OP-SCC. There are limited reports on practice patterns and outcomes associated with post-operative radiation therapy (PORT) or chemoradiation (POCRT) for HPV-associated OP-SCCs.The National Cancer Database was queried for patients with HPV-associated OP-SCCs managed initially with surgery with IRFs or HRFs. IRFs were defined as pT3/T4 disease, pN1-3 disease, and lymphovascular space invasion, and HRFs as positive margins and extranodal extension (ENE). Patients were stratified into no adjuvant therapy, PORT, or POCRT arms. Kaplan-Meier analysis was utilized for comparison of overall survival (OS) between treatment arms followed by a Cox multivariate (MVA) proportional-hazards model and propensity score analyses with inverse probability treatment weighting (IPTW).We identified 6,301 patients; 51.2% had IRFs only and 48.8% had HRFs. Regarding treatment, 25.5%, 38.2%, and 36.3% of patients received no RT, PORT, and POCRT, respectively. Patients with IRFs who did not receive RT or CRT had inferior 8-year OS (81.1% vs. 87.8%; p < 0.001) that remained significant on IPTW MVA (hazard ratio (HR) = 1.69 (95% CI: 1.27-2.24; p < 0.001). Among patients with HRFs, 8-year OS was not significantly different between patients receiving PORT vs. POCRT (77.3% vs. 79.2%; p = 0.22) that remained insignificant on IPTW MVA (HR = 0.91(0.72-1.17); p = 0.48).A significant proportion of HPV-associated OP-SCC patients with IRFs or HRFs did not receive PORT, which was associated with inferior OS. We did not demonstrate with statistical power that POCRT vs. PORT was associated with superior OS in patients with HRFs, though prospective studies are warranted.Copyright © 2023 Elsevier Ltd. All rights reserved.