# PATH classification: a proposal for patients with HNSCC treated with salvage surgery

## TL;DR

This study proposes a new PATH classification system for head and neck cancer patients undergoing salvage surgery, which better predicts survival outcomes than the current standard.

## Contribution

A novel PATH classification system is introduced for recurrent HNSCC patients, offering improved prognostic accuracy compared to the rpTNM system.

## Key findings

- PATH classification divides patients into four stages with distinct 5-year survival rates ranging from 3.7% to 82.8%.
- PATH classification showed better prognostic discrimination than the existing rpTNM classification.
- The classification considers tumor location, pathologic extension, surgical margins, and lymph node metastases with extracapsular spread.

## Abstract

The aim of this study is to propose a classification for patients with recurrent head and neck squamous cell carcinoma (HNSCC) treated with salvage surgery based on the location of the primary tumor and data commonly found in the pathological report of the resection.

Retrospective study of 665 patients with HNSCC treated with a salvage surgery after a local and/or regional recurrence of the tumor.

We propose a new postoperative classification for patients with recurrent HNSCC treated with salvage surgery. PATH classification stratifies patients into 4 stages based on the glottic or non-glottic location of the primary tumor, the local and regional pathologic extension of the tumor, the status of the surgical margins, and the presence of lymph node metastases with extracapsular spread. The PATH classification was more homogeneous in the prognosis of patients included in each of its stages, and it had a better prognostic discrimination capacity between stages than the rpTNM classification. According to the PATH classification, the 5-year disease-specific survival was: PATH I (n = 306) 82.8%; PATH II (n = 119) 47.1%; PATH III (n = 202) 24.4%; PATH IV (n = 38) 3.7%. For the rpTNM classification, the 5-year disease-specific survival was: stage I (n = 119) 85.1%; stage II (n = 134) 68.4%; stage III (n = 111) 59.5%; stage IV (n = 301) 33.3%.

The PATH classification for HNSCC patients with local and/or regional recurrence treated with salvage surgery had a better prognostic capacity than the rpTNM classification.

Level IV.

The online version contains supplementary material available at 10.1007/s00405-024-08961-x.