Oncologic outcomes of salvage surgery and immune checkpoint inhibitor therapy in recurrent head and neck squamous cell carcinoma: A single‐institution retrospective study

Abstract

Background Survival outcomes in recurrent head and neck squamous cell carcinoma (HNSCC) are poor. This study aimed to compare survival outcomes between salvage surgery and immunotherapy in patients with recurrent advanced HNSCC. Methods Patients with advanced stage (stage III or IV) recurrent HNSCC following treatment with platinum‐based chemotherapy were included. Survival was estimated using the Kaplan–Meier method, and Cox regression was used for multivariate logistic regression. Results Two‐year overall survival after salvage surgery was 68.6% and after immunotherapy patients was 24.6%. Multivariate logistic regression showed that salvage surgery was associated with improved survival without statistical significance (hazard ratio [HR] 0.12, p = 0.25). Subgroup analysis of patients with oral cavity/oropharyngeal cancer noted improved survival with salvage surgery over immunotherapy (HR 0.006, p = 0.01) and decreased survival with neutrophil‐to‐lymphocyte ratio (NLR) > 5 (HR 6.4, p = 0.02). Conclusion Our retrospective single‐institutional data suggest that resectable advanced stage recurrent HNSCC may have improved survival with salvage surgery in appropriately selected patients, but larger prospective studies are required.

Effects of immune inflammation in head and neck squamous cell carcinoma: Tumor microenvironment, drug resistance, and clinical outcomes

“…Membrane GO MF was mainly enriched in receptor ligand activity, carbohydrate binding, and the following cytokine activity KEGG pathway: neuroactive ligand-receptor interaction. These results suggest that the main differences between the high- and low-risk groups are immune-related, which was consistent with previous results ( Yuan et al, 2022b ; Konuthula et al, 2022 ). Therefore, we further performed a CIBERSORT immune infiltration analysis, which showed that the differential gene expression levels of the 25 relevant inflammatory factors were associated with immune function and increased the risk scores.…”

Impact of comorbidities on outcomes in patients with advanced head and neck cancer undergoing immunotherapy

“…However, this is the largest study to our knowledge that investigates the predictive significance of CCI in patients with stage IV HNC receiving treatment with immunotherapies in particular. In a retrospective analysis of patients with advanced stage recurrent HNC treated with immunotherapy, Konuthula et al found CCI score to not be predictive of OS; however, this analysis was limited by a small sample size ( N = 44) 17 . Further research is needed to confirm these findings for other stages of HNC disease.…”

“…In a retrospective analysis of patients with advanced stage recurrent HNC treated with immunotherapy, Konuthula et al found CCI score to not be predictive of OS; however, this analysis was limited by a small sample size (N = 44). 17 Further research is needed to confirm these findings for other stages of HNC disease.…”

Evolving treatment paradigms in recurrent and metastatic head and neck squamous cell carcinoma: the emergence of immunotherapy

“…In a first of its kind analysis, implementing a single-institution retrospective study design, Konuthula and colleagues compared oncologic outcomes of salvage surgery and ICI therapy as first line treatment in patients with recurrent HNSCC without distant metastasis who failed primary chemoradiotherapy ( 13 ). In their cohort, 2-year overall survival for patients who underwent salvage surgery was 69%, but only 25% in those who received ICI immunotherapy.…”