The impact of neoadjuvant immunochemotherapy on the prognosis of locally advanced oral carcinoma

TL;DR

Adding immunotherapy to pre-surgery treatment for advanced oral cancer improves survival and reduces recurrence.

Contribution

Demonstrates that neoadjuvant immunochemotherapy improves prognosis in locally advanced oral squamous cell carcinoma.

Findings

Neoadjuvant immunochemotherapy significantly improved 3-year overall survival compared to direct surgery.

Treatment with neoadjuvant immunochemotherapy also significantly improved 3-year disease-free survival.

Adverse events from neoadjuvant immunochemotherapy were mostly mild and resolved with treatment.

Abstract

This study aimed to investigate the effect of preoperative neoadjuvant immunochemotherapy (NAICT) on the prognosis of patients with locally advanced oral squamous cell carcinomas (OSCC), thereby providing evidence-based guidance for the clinical management of OSCC.

We conducted a retrospective cohort study of OSCC cases treated at our institution between 2017 and 2022. Kaplan–Meier survival curves, along with univariate and multivariate Cox regression analyses, were employed to identify independent factors influencing 3-year overall survival (OS) and disease-free survival (DFS) rates.

A total of 158 patients with locally advanced OSCC were included. 119 patients received simple surgical treatment, 15 patients underwent neoadjuvant chemotherapy (NAC) followed by surgery and 24 patients underwent NAICT followed by surgery. Multivariate analysis identified differentiation (P = 0.041), negative margins (P = 0.043), N stage (P = 0.046), treatment strategy (P = 0.016), postoperative recurrence (P < 0.001), and postoperative metastasis (P = 0.044) as independent factors influencing 3-year OS. For 3-year DFS, the independent factors included negative margins (P = 0.017), N stage (P = 0.006), treatment strategy (P = 0.004), postoperative recurrence (P < 0.001), and post-operative metastasis (P < 0.001). Compared to direct surgery, surgery following NAC showed no significant difference in 3-year OS (53.3% vs. 57.1%, P = 0.701) and 3-year DFS (33.3% vs. 52.9%, P = 0.099). Compared to direct surgery, preoperative NAICT significantly improved 3-year OS (82.4% vs. 57.1%, P = 0.004) and 3-year DFS (83.3% vs. 52.9%, P = 0.007). Furthermore, compared to surgery following NAC, preoperative NAICT was associated with a significantly improved 3-year OS (82.4% vs. 53.3%, P = 0.03) and 3-year DFS (83.3% vs. 33.3%, P = 0.001). Treatment-related adverse events occurred in 70.8% of patients receiving NAICT. All events were grade 1–2 in severity and resolved following treatment.

Compared to direct surgery or NAC followed by surgery, preoperative NAICT demonstrated a more favorable impact on the prognosis of patients with locally advanced OSCC, while exhibiting manageable treatment-related adverse effects.

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