Outcomes in patients with head and neck squamous cell carcinoma with exclusively surgical resection

TL;DR

This study found that patients with early-stage head and neck cancer who had surgery alone had good survival rates, but smoking greatly increased the risk of death and recurrence.

Contribution

The study identifies smoking and other histopathological factors as strong predictors of outcomes in patients undergoing exclusive surgical resection for head and neck cancer.

Findings

5-year overall survival was 74.7% among patients with early-stage head and neck squamous cell carcinoma.

Active smokers had a 9.4 times higher risk of death and a 9.7 times higher risk of recurrence.

Positive surgical margins and perineural invasion were linked to worse disease-free survival.

Abstract

•The overall survival at 5-years was estimated at 74.7%.•The disease-free survival at 5-years was estimated at 69.3%.•Active smoking patients had a 9.4 times higher risk of death.•Active smoking patients had a 9.7 times higher risk of recurrence.

The overall survival at 5-years was estimated at 74.7%.

The disease-free survival at 5-years was estimated at 69.3%.

Active smoking patients had a 9.4 times higher risk of death.

Active smoking patients had a 9.7 times higher risk of recurrence.

To estimate patients’ overall and disease-free survival with squamous cell carcinoma of the oral cavity, oropharynx, and larynx, and assess the influence of primary local staging and histopathological features on these outcomes.

Retrospective data analysis of 102 patients with head and neck squamous cell carcinoma who underwent exclusive surgery as the initial treatment modality. p16 analysis was not evaluated. Exclusion criteria included patients with synchronous or metachronous tumors, those undergoing adjuvant or neoadjuvant chemotherapy or radiotherapy, and those with prior surgery at the exact site. Univariate and multivariate Cox Regression analyses were performed to evaluate outcome-related factors. Survival curves were estimated using the Kaplan-Meier method.

The majority presented early stage I and II (83.4%), T1/T2 tumors (86.2%), N0 (95.1%), and all M0. The primary sites were mainly the larynx (46.1%) and oral cavity (41.2%). The mean overall survival was 71.76 months, with survival rates at 1-, 2-, 3-, 4-, and 5-years of 95.9%, 88.2%, 85.5%, 80.4%, and 74.7%, respectively. The mean disease-free survival was 68.2 months, with rates at 1-, 2-, 3-, 4-, and 5-years of 87.5%, 85.1%, 82.2%, 76.6%, and 69.3%, respectively. Active smoking was associated with a higher risk of death (HR = 9.4, p <  0.001) and recurrence (HR = 9.7, p <  0.001). Active smoking patients with perineural invasion presented worse overall and disease-free survival. Positive margins were associated with reduced disease-free survival.

Exclusive surgery in the early stages (I and II) emerges as a practical approach. Stage, primary site, margins, perineural invasion, lymphovascular invasion, and smoking cessation were the significant prognostic factors that affected patient outcomes.

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