Failure to achieve textbook outcome predicts poor survival in p16 negative oropharyngeal squamous cell carcinoma

Background: This study evaluated the prognostic significance of achieving a textbook outcome (TO) in patients with surgically treated p16-negative oropharyngeal squamous cell carcinoma (OPSCC). Methods: A total of 194 patients with p16-negative OPSCC who underwent radical surgery and neck dissection between 2007 and 2017 were included. Cox proportional hazards models were applied to identify factors associated with overall survival (OS) and disease-free survival (DFS). Results: Among the cohort, 100 patients (51.5%) achieved a TO. Patients in the TO group demonstrated significantly better 5-year OS rates (76.5% vs. 52.3%, p < 0.001) and 5-year DFS rates (72.2% vs. 47.2%, p = 0.001) compared with those in the non-TO group. Multivariate analysis revealed that failure to achieve a TO be an independent negative predictor of OS (hazard ratio [HR] 1.824, 95% confidence interval [CI] 1.126–2.957, p = 0.015) and DFS (HR 1.662, 95% CI 1.044–2.645, p = 0.032). Conclusion: Failure to achieve a TO is associated with poorer long-term outcomes in surgically treated patients with p16-negative OPSCC. Therefore, TO may serve as a practical, composite proxy for evaluating and improving surgical quality in this population.