Clin Exp Otorhinolaryngol.  2021 May;14(2):225-234. 10.21053/ceo.2020.01732.

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

• Park JO
• Park YM
• Jeong WJ
• Shin YS
• Hong YT
• Choi IJ
• Kim JW
• Woo SH
• Kim YS
• Chang JW
• Kim MS
• Jung KY
• Ahn SH
• Kim CH
• Hong KH
• Chung PS
• Kim YM
• Kim SH
• Baek SK

• KMID: 2515436
• DOI: http://doi.org/10.21053/ceo.2020.01732

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.

Keyword

Squamous Cell Carcinoma of Head And Neck; Oral Neoplasms; Oropharyngeal Neoplasm; Laryngeal Neoplasms; Hypopharyngeal Neoplasms; Survival; Disease-Free Survival; Survival Rate; Prognosis; Surgery

Figure

• 

  Fig. 1 Schema of the cohort. The study design, including the allocation of patients to the surgery group and CRT group according to the primary treatment modality, is shown. HNSC, head and neck squamous cell carcinoma; Surgery group, patients treated primarily by surgery with curative intent with/without (neo)adjuvant treatment; CRT group, patients treated primarily with chemotherapy and radiotherapy; Neo, neoadjuvant chemotherapy; RT, radiotherapy; CRT, chemoradiation therapy.

• 

  Fig. 2 The proportion of surgery-based treatments in patients (n=1,033) with stage IVa head neck cancer, shown by anatomical location of the primary tumor. CRT group, patients treated primarily with chemotherapy and radiotherapy; Surgery group, patients treated primarily by surgery with curative intent with/without (neo)adjuvant treatment; HNSC, head and neck squamous cell carcinoma.

• 

  Fig. 3 Kaplan-Meier survival curves for patients with stage IVa HNSC (n=1,033). (A) Overall survival (OS), (B) disease-free survival (DFS) treated surgically (surgery group) or nonsurgically (CRT group). HNSC, head and neck squamous cell carcinoma; Surgery group, patients treated primarily by surgery with curative intent with/without (neo)adjuvant treatment; CRT group, patients treated primarily with chemotherapy and radiotherapy. *Statistically significant (P<0.05).

• 

  Fig. 4 Kaplan-Meier survival curves according to treatment modality and primary tumor site or T4a stage. Oral cancer (n=329): (A) overall survival (OS) and (B) disease-free survival (DFS). Oropharynx (n=301): (C) OS and (D) DFS. Larynx (n=165): (E) OS and (F) DFS. Hypopharynx (n=238): (G) OS and (H) DFS. Non-T4a (n=582): (I) OS and (J) DFS. Surgery group, patients treated primarily by surgery with curative intent with/without (neo)adjuvant treatment; CRT group, patients treated primarily with chemotherapy and radiotherapy. *Statistically significant (P<0.05).

• 

  Fig. 5 Survival benefits from surgery by primary tumor site or T4a stage. (A) Overall survival, (B) disease-free survival. CI, confidence interval; CRT group, patients treated primarily with chemotherapy and radiotherapy. *Statistically significant (P<0.05).

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