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Scientific Oral Presentations

Head and Neck Surgery

Session: Scientific Presentation 2 - Head and Neck Surgery

Preoperative Neutrophil-to-lymphocyte Ratio Predicts Recurrence in Patients with HPV(+) Oropharyngeal Cancer Undergoing Transoral Robotic Surgery

Sunday, October 12, 2025
8:42 AM - 8:48 AM EDT
Location: 127
Disclosure(s):
Micah K. Harris, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Kelly E. Daniels, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Vanessa Helou, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Matthew E. Spector, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Kevin J. Contrera, MD, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Pre-treatment neutrophil-to-lymphocyte ratio (NLR) has been found to be prognostic of survival outcomes in patients with oropharyngeal squamous cell carcinoma (OPSCC) undergoing definitive radiotherapy or chemoradiotherapy. However, the prognostic significance of NLR for patients undergoing primary treatment with transoral robotic surgery (TORS) for human papillomavirus positive (HPV+) OPSCC has not well explored.

Methods: A retrospective cohort of patients from April 2014 to October 2021 were collected. Patients who underwent TORS for HPV+ OPSCC and had preoperative CBC within 1 month of surgery were included. Data collected included age, race, recurrence, recurrence location, death, smoking status at diagnosis, radiation therapy, preoperative CBC, T and N stage (AJCC 8th edition), follow up duration, surgical margins, extranodal extension, perineural invasion, and angiolymphatic invasion.

Results: A total of 134 patients were included (85.8% male, 93.2% Caucasian, 60 ± 9.13 years old). 67.1% were smokers and 67.3% completed adjuvant RT or CRT. Average T stage was 1.6 ± 0.6 and N stage was 1.52 ± 1.09. 18.6% of patients had positive margins, 41.5% had extranodal extension, 6.9% had perineural invasion, and 59.5% had angiolymphatic invasion. Average postoperative follow up duration was 52 ± 32.4 months. A total of 15 patients (11.2%) recurred (23.4 ± 22.2 months postoperatively), of which 7 were distant metastases, for an overall recurrence free survival (RFS) of 88.8%. Overall survival for the cohort was 91.8%. On Kaplan Meier curve analysis, those with preoperative NLR < 2 had a 5-year RFS of 100% versus 85.2% for those with an NLR of >2 (P=0.0073). 5-year overall survival was similar between patients with NLR >2 versus NLR < 2 (P>0.05). When controlling for smoking status on multivariate logistic regression, NLR >2 remained a significant predictor of recurrence (odds ratio 4.83, P=0.047).

Conclusions: A preoperative NLR of < 2 predicted improved 5-year recurrence free survival in a cohort of patients with HPV+ OPSCC who underwent TORS.

    Presenting Author(s)

  • MH

    Micah K. Harris, MD

    Resident, Department of Otolaryngology
    University of Pittsburgh Medical Center, Department of Otolaryngology - Head and Neck Surgery
    pittsburgh, Pennsylvania, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • KD

    Kelly E. Daniels, MD

    Fellow - Rhinology and Skull Base
    University of Pittsburgh Medical Center
    Pittsburgh, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • ES

    Elizabeth Sell, MD

    UPMC, United States

    Disclosure information not submitted.

  • Vanessa Helou, MD

    Postdoctoral Research Associate
    Department of Otolaryngology, University of Pittsburgh
    Pittsburgh, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Shivam D. Patel, MD

    Resident Physician
    Department of Otolaryngology, University of Pittsburgh Medical Center
    Pittsburgh, PA, United States

    Disclosure information not submitted.

  • JS

    Joshua D. Smith, MD

    Resident
    University of Pittsburgh Otolaryngology
    Ann Arbor, MI, United States

    Disclosure information not submitted.

  • Matthew E. Spector, MD

    Professor
    Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh
    Pittsburgh, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • SS

    Shaum S. Sridharan, MD

    Associate Professor
    Department of Otolaryngology, University of Pittsburgh Medical Center
    Pittsburgh, PA, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Kevin J. Contrera, MD, MPH

    Assistant Professor
    University of Pittsburgh
    Pittsburgh, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.