Oral oncology · 2026
Identification of prognostic variables in patients with recurrent head and neck squamous cell carcinoma treated with salvage surgery: Implications for treatment with immunotherapy.
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Holgado Anna, Llansana Albert, Vázquez Cristina, Gallego Óscar, Aguado Maria, Valero Cristina, León Xavier
Аннотация
OBJECTIVES: This study aimed to identify clinical prognostic variables for patients with recurrent head and neck squamous cell carcinoma (HNSCC) treated with salvage surgery. The goal was to discriminate patients with a 5-year disease-specific survival (DSS) below 20%, a threshold below which immunotherapy could be considered an adequate therapeutic option.
MATERIAL AND METHODS: This was a retrospective study including 402 patients diagnosed with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx between 2000 and 2022 who experienced local and/or regional recurrence and were treated with salvage surgery. Prognostic variables related to the patient, initial tumor, initial treatment, and recurrence were analyzed. A recursive partitioning analysis using disease-specific survival as the dependent variable was used to define prognostic categories.
RESULTS: The mean follow-up was 5.1 years. The 5-year DSS for the study cohort was 53.6%. Four prognostic categories were obtained with the recursive partitioning analysis. Patients in the category with the worst prognosis (Category IV, n = 84) had a 5-year DSS of 14.0% (95% CI: 6.2-21.8%). This group included patients with oropharynx/hypopharynx tumors with local recurrence rcT ≥ 2 and no regional recurrence or rcN1, and patients with regional recurrence rcN ≥ 2 and simultaneous local recurrence.
CONCLUSION: A subgroup of recurrent HNSCC patients was identified with a particularly poor prognosis, showing a 5-year DSS below 20%. Considering the survival plateau of around 20% seen with immunotherapy in recurrent/metastatic HNSCC, immunotherapy could be a reasonable therapeutic alternative for these high-risk patients, potentially offering comparable or superior outcomes with reduced morbidity compared to salvage surgery.
MATERIAL AND METHODS: This was a retrospective study including 402 patients diagnosed with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx between 2000 and 2022 who experienced local and/or regional recurrence and were treated with salvage surgery. Prognostic variables related to the patient, initial tumor, initial treatment, and recurrence were analyzed. A recursive partitioning analysis using disease-specific survival as the dependent variable was used to define prognostic categories.
RESULTS: The mean follow-up was 5.1 years. The 5-year DSS for the study cohort was 53.6%. Four prognostic categories were obtained with the recursive partitioning analysis. Patients in the category with the worst prognosis (Category IV, n = 84) had a 5-year DSS of 14.0% (95% CI: 6.2-21.8%). This group included patients with oropharynx/hypopharynx tumors with local recurrence rcT ≥ 2 and no regional recurrence or rcN1, and patients with regional recurrence rcN ≥ 2 and simultaneous local recurrence.
CONCLUSION: A subgroup of recurrent HNSCC patients was identified with a particularly poor prognosis, showing a 5-year DSS below 20%. Considering the survival plateau of around 20% seen with immunotherapy in recurrent/metastatic HNSCC, immunotherapy could be a reasonable therapeutic alternative for these high-risk patients, potentially offering comparable or superior outcomes with reduced morbidity compared to salvage surgery.