Response-adapted surgery after neoadjuvant immunochemotherapy in oral squamous cell carcinoma

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology Pub Date : 2025-12-01 Epub Date: 2025-11-03 DOI:10.1016/j.oraloncology.2025.107769

Qigen Fang , Junhui Yuan , Xu Zhang , Tao Huang , Lanwei Guo

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引用次数: 0

Abstract

Objective

The standard treatment for locally advanced oral squamous cell carcinoma (OSCC) involves radical surgery followed by adjuvant therapy, often resulting in significant functional impairment. Neoadjuvant immunochemotherapy (NICT) has emerged as a promising strategy to facilitate surgical de-escalation while preserving oncologic outcomes. This study evaluates the feasibility of response-adapted surgery (RAS) following NICT in OSCC.

Methods

In this retrospective analysis, 152 patients with previously untreated OSCC received NICT followed by either RAS (n = 66) or traditional surgery (TS, n = 86). RAS was tailored to post-NICT tumor regression, while TS adhered to pretreatment tumor extent. Primary endpoints were 3-year event-free survival (EFS) and overall survival (OS). Secondary endpoints included quality of life (QoL, assessed via EORTC QLQ-HN35) and perioperative complications.

Results

The RAS and TS cohorts exhibited comparable 3-year EFS (78.8 % vs. 79.1 %, p = 0.944) and OS (90.9 % vs. 91.9 %, p = 0.826). RAS significantly reduced the need for mandibulectomy (16.7 % vs. 41.9 %, p = 0.009) and free flap reconstruction (15.2 % vs. 48.8 %, p = 0.018), with fewer major complications (4.5 % vs. 11.6 %, p = 0.048). QoL metrics favored RAS, particularly in swallowing (15 ± 3.8 vs. 28 ± 5.5, p < 0.001) and speech (14 ± 3.9 vs. 25 ± 5.2, p < 0.001) at 12 months. Major pathologic response and PD-L1 CPS > 20 were associated with improved survival.

Conclusions

RAS after NICT achieves oncologic outcomes equivalent to TS while significantly reducing treatment-related morbidity and improving functional recovery. These findings support RAS as a viable de-escalation strategy for OSCC, aligning with the goals of precision oncology. Prospective trials are needed to validate long-term efficacy and refine patient selection criteria.

查看原文本刊更多论文

口腔鳞状细胞癌新辅助免疫化疗后的反应适应手术。

目的：局部晚期口腔鳞状细胞癌（OSCC）的标准治疗包括根治性手术和辅助治疗，这往往导致严重的功能损害。新辅助免疫化疗（NICT）已成为一种有希望的策略，以促进手术降级，同时保持肿瘤预后。本研究评估了OSCC NICT后反应适应性手术（RAS）的可行性。方法：在本回顾性分析中，152例既往未治疗的OSCC患者接受NICT，随后接受RAS （n = 66）或传统手术（n = 86）。RAS是针对nict后肿瘤消退量身定制的，而TS则是针对nict前肿瘤程度量身定制的。主要终点为3年无事件生存期（EFS）和总生存期（OS）。次要终点包括生活质量（QoL，通过EORTC QLQ-HN35评估）和围手术期并发症。结果：RAS组和TS组的3年EFS（78.8%比79.1%,p = 0.944）和OS（90.9%比91.9%,p = 0.826）具有可比性。RAS显著减少了下颌切除术（16.7%对41.9%,p = 0.009）和游离皮瓣重建（15.2%对48.8%,p = 0.018）的需求，减少了主要并发症（4.5%对11.6%,p = 0.048）。生活质量指标支持RAS，特别是吞咽（15±3.8 vs 28±5.5,p 20）与生存率提高相关。结论：NICT后RAS达到了与TS相当的肿瘤学结果，同时显著降低了治疗相关的发病率并改善了功能恢复。这些发现支持RAS作为一种可行的OSCC降级策略，与精确肿瘤学的目标一致。需要前瞻性试验来验证长期疗效并完善患者选择标准。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oral oncology 医学-牙科与口腔外科

CiteScore

8.70

自引率

10.40%

发文量

505

审稿时长

20 days

期刊介绍： Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck. Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.