Perioperative symptom burden as an independent predictor of long-term functional and survival outcomes in oral squamous cell carcinoma patients undergoing free flap reconstruction: a retrospective cohort study.

Abstract

This study aimed to evaluate the prognostic significance of acute perioperative symptom burden as an independent predictor for long-term functional recovery and survival outcomes in patients with oral squamous cell carcinoma (OSCC) undergoing microvascular free flap reconstruction. A retrospective cohort of 355 OSCC patients treated between June 2022 and December 2024 at Henan Provincial People's Hospital was analyzed. All patients underwent primary tumor resection followed by immediate microvascular free flap reconstruction. Perioperative symptom burden was quantified using the validated MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN). Based on the median core severity score on postoperative day 3 (POD 3) of 5.79, patients were stratified into low symptom burden (n=178) and high symptom burden (n=177) groups. Over a 12-month follow-up period, comprehensive assessments encompassed long-term speech function measured by the Speech Handicap Index (SHI) and Percent Consonants Correct (PCI), swallowing function evaluated via the MD Anderson Dysphagia Inventory (MDADI), quality of life assessed by the University of Washington Quality of Life questionnaire (UW-QOL) and the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N), as well as survival outcomes. Multivariate linear regression, Cox proportional hazards models, and subgroup analyses were employed to ascertain the independent prognostic value of symptom burden. Findings revealed that elevated perioperative symptom burden was significantly associated with delayed and incomplete functional recovery. At 12 months, the high symptom burden cohort demonstrated markedly worse SHI scores (29.2 vs. 19.2, t=12.45, P<0.001), reduced PCI (84.4% vs. 94.4%, t=-15.32, P<0.001), and lower MDADI scores (84.0 vs. 94.0, t=-14.88, P<0.001). Multivariate analysis identified the area under the curve (AUC) of the perioperative MDASI severity trajectory as an independent predictor for 12-month SHI (B=2.83, 95% CI 1.52-4.14, P=0.001) and UW-QOL scores (B=-3.82, 95% CI -5.14 to -2.50, P=0.001). Furthermore, a high symptom burden was independently correlated with poorer overall survival (Log-rank P=0.019) and recurrence-free survival (Log-rank P=0.025); Cox regression confirmed high symptom burden as an independent risk factor for overall survival (HR=1.78, 95% CI 1.06-2.99, P=0.029). Subgroup analyses upheld the robustness of these associations across diverse clinical and demographic strata. In conclusion, acute perioperative symptom burden transcends being a mere transient reflection of surgical trauma, serving instead as a pivotal independent prognosticator of long-term functional outcomes, quality of life, and survival in OSCC patients undergoing free flap reconstruction. Early identification and proactive management of perioperative symptoms may constitute a novel therapeutic avenue to enhance both oncologic and functional prognoses.