Neoadjuvant chemotherapy vs upfront surgery for resectable locally advanced oral squamous cell carcinoma: A retrospective single center study.

Abstract

Background: Oral squamous cell carcinoma (OSCC) is one of the most common cancers in humans. The role of neoadjuvant chemotherapy (NAC) in OSCC remains controversial.

Objectives: The study aimed to investigate the effect of NAC on locally advanced OSCC and identify prognostic factors varying is different therapies to ultimately guide the optimal selection of future treatment.

Material and methods: A total of 156 patients with locally advanced OSCC were enrolled. The clinical characteristics and survival outcomes of patients with and without NAC were compared. The primary endpoint was overall survival (OS), and the secondary endpoint was disease-free survival (DFS).

Results: Among the 156 patients enrolled in this study, 81 patients received NAC followed by surgery and 75 patients received surgery alone. No significant difference in OS at 3 years was detected (78.3% vs 79.8%, p = 0.76). However, a significantly worse DFS was observed in the NAC group (42.4% vs 59.2%, p = 0.048). Within the NAC group, 50 patients (61.7%) had a favorable clinical response, and 12 patients (14.8%) had a complete pathological response. Better survival outcomes were observed in patients with favorable clinical responses. In stratified analysis, patients of pT3/4 OSCC after NAC showed worse DFS than those of the same stage who underwent surgery alone (40.2% vs 58%, p = 0.033). In Cox regression, clinical response and pathological stage were predictors of survival in the NAC group, while pathological stage was the only predictor of OS in the surgery group.

Conclusions: Patients with advanced pathological stages after NAC may be at a higher risk of treatment failure, and upfront surgery is recommended for locally advanced OSCC patients in current clinical practice.