Survival Benefits From Surgery for Stage IVa Head and Neck Squamous Cell Carcinoma: A Multi-Institutional Analysis of 1,033 Cases

Abstract

Objectives. Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). Methods. We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. Results. Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592-0.981; OR for recurrence, 0.628; 95% CI, 0.492-0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341-0.879; OR for recurrence, 0.598; 95% CI, 0.377-0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211-0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328-0.780). Conclusion. A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.

Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients

“…These free flaps led to significant improvements in functional recovery after surgery in patients with head and neck malignancies. In addition, reconstructive surgery using these flaps is expected to become increasingly important due to their benefits for advanced oropharyngeal and laryngeal cancers [ 25 ].…”

A circulating microRNA panel as a novel dynamic monitor for oral squamous cell carcinoma

“…Due to the high occurrence of secondary carcinoma and tumor heterogeneity, OSCC is often diagnosed in an advanced state with a poor prognosis 2 . Even though most cases of OSCC could be managed with complete surgical resection alone or a combination of ionizing radiation or chemo-radiation therapy, a certain proportion of advanced OSCCs remain unresponsive to treatment or exhibit loco-regional recurrence, resulting in a mortality rate of 50% 3 , 4 .…”

Clinical significance and integrative analysis of the cuproptosis-associated genes in head and neck squamous cell carcinoma

“…Although there are a large number of basic studies and treatment options for clinical selection, the 5-year mortality in patients with HNSC remains below 50% [4]. Recurrence or metastasis is the majority of reasons for the poor prognosis of patients after conventional chemotherapy, radiotherapy or combination therapy.…”

“…Studies have shown that the infection of HPV can also promote the development of HNSC, especially in oropharyngeal squamous cell carcinoma (OSCC) [ 3 ]. Although there are a large number of basic studies and treatment options for clinical selection, the 5-year mortality in patients with HNSC remains below 50% [ 4 ]. Recurrence or metastasis is the majority of reasons for the poor prognosis of patients after conventional chemotherapy, radiotherapy or combination therapy.…”