Delay to surgery after neoadjuvant chemotherapy in head and neck squamous cell carcinoma affects oncologic outcomes
Background Neoadjuvant chemotherapy (NAC) is used in head and neck squamous cell carcinoma (HNSCC) for downstaging advanced disease and decreasing distant metastasis (DM). To the authors' knowledge, no study has specifically examined the impact of a delayed time to surgery (TTS) after NAC on on...
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| Veröffentlicht in: | Cancer 2021-06, Vol.127 (12), p.1984-1992 |
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| container_title | Cancer |
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| creator | Kiong, Kimberley L. Yao, Christopher M. K. L. Lin, Fang‐Yu Bell, Diana Ferrarotto, Renata Weber, Randal S. Lewis, Carol M. |
| description | Background
Neoadjuvant chemotherapy (NAC) is used in head and neck squamous cell carcinoma (HNSCC) for downstaging advanced disease and decreasing distant metastasis (DM). To the authors' knowledge, no study has specifically examined the impact of a delayed time to surgery (TTS) after NAC on oncologic outcomes. They thus aimed to identify a cutoff for TTS after NAC and its effect on survival indices.
Methods
This was a retrospective review of all patients with HNSCC receiving NAC followed by surgery with curative intent between March 2016 and March 2019 at the MD Anderson Cancer Center. Receiver operating characteristic analysis was used to identify a cutoff for TTS, and this cutoff was used to analyze the overall survival (OS), locoregional recurrence rate, DM‐free rate, and disease‐free survival (DFS). A multivariate Cox regression analysis was performed.
Results
One hundred one patients were analyzed with a median follow‐up of 24.7 months. The 3‐year OS and locoregional recurrence rates did not differ with a TTS ≥ 34 days. However, the 3‐year DM‐free rate was significantly worse (56% vs 90%; P = .001) in the group with a TTS ≥ 34 days, and the 3‐year DFS was significantly lower (26% vs 64%; P = .006). In a multivariate analysis, a TTS ≥ 34 days (hazard ratio [HR], 4.92; 95% confidence interval [CI], 1.84‐13.13) and extracapsular extension (HR, 3.01; 95% CI, 1.13‐8.00) were significant independent predictors of a poorer DM‐free rate. Weight loss > 10% (HR, 5.53; 95% CI, 1.02‐30.24) was the only independent predictor for a TTS ≥ 34 days.
Conclusions
Emphasis should be placed on early definitive locoregional treatment after NAC, particularly in patients who do not respond to NAC. There is a need to validate these findings and establish new benchmarks for the interval between NAC and surgery.
A delay to surgery after neoadjuvant chemotherapy for head and neck squamous cell carcinoma results in a higher distant metastasis rate and poorer disease‐free survival. |
| doi_str_mv | 10.1002/cncr.33471 |
| format | Article |
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Neoadjuvant chemotherapy (NAC) is used in head and neck squamous cell carcinoma (HNSCC) for downstaging advanced disease and decreasing distant metastasis (DM). To the authors' knowledge, no study has specifically examined the impact of a delayed time to surgery (TTS) after NAC on oncologic outcomes. They thus aimed to identify a cutoff for TTS after NAC and its effect on survival indices.
Methods
This was a retrospective review of all patients with HNSCC receiving NAC followed by surgery with curative intent between March 2016 and March 2019 at the MD Anderson Cancer Center. Receiver operating characteristic analysis was used to identify a cutoff for TTS, and this cutoff was used to analyze the overall survival (OS), locoregional recurrence rate, DM‐free rate, and disease‐free survival (DFS). A multivariate Cox regression analysis was performed.
Results
One hundred one patients were analyzed with a median follow‐up of 24.7 months. The 3‐year OS and locoregional recurrence rates did not differ with a TTS ≥ 34 days. However, the 3‐year DM‐free rate was significantly worse (56% vs 90%; P = .001) in the group with a TTS ≥ 34 days, and the 3‐year DFS was significantly lower (26% vs 64%; P = .006). In a multivariate analysis, a TTS ≥ 34 days (hazard ratio [HR], 4.92; 95% confidence interval [CI], 1.84‐13.13) and extracapsular extension (HR, 3.01; 95% CI, 1.13‐8.00) were significant independent predictors of a poorer DM‐free rate. Weight loss > 10% (HR, 5.53; 95% CI, 1.02‐30.24) was the only independent predictor for a TTS ≥ 34 days.
Conclusions
Emphasis should be placed on early definitive locoregional treatment after NAC, particularly in patients who do not respond to NAC. There is a need to validate these findings and establish new benchmarks for the interval between NAC and surgery.
A delay to surgery after neoadjuvant chemotherapy for head and neck squamous cell carcinoma results in a higher distant metastasis rate and poorer disease‐free survival.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/cncr.33471</identifier><identifier>PMID: 33631040</identifier><language>eng</language><publisher>HOBOKEN: Wiley</publisher><subject>Benchmarks ; Cancer ; Chemotherapy ; Confidence intervals ; Disease-Free Survival ; Head & neck cancer ; head and neck neoplasms ; Head and Neck Neoplasms - drug therapy ; Head and Neck Neoplasms - surgery ; Humans ; Life Sciences & Biomedicine ; Metastases ; Multivariate analysis ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local - pathology ; Oncology ; Patients ; Regression analysis ; Retrospective Studies ; Science & Technology ; Squamous cell carcinoma ; Squamous Cell Carcinoma of Head and Neck - drug therapy ; Squamous Cell Carcinoma of Head and Neck - surgery ; Statistical analysis ; Surgery ; Survival ; Weight loss</subject><ispartof>Cancer, 2021-06, Vol.127 (12), p.1984-1992</ispartof><rights>2021 American Cancer Society</rights><rights>2021 American Cancer Society.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>4</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000621570600001</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c4591-d3a95602809b2a61a11579d7ca46a834908c8434e233316034ca20ee80a11f83</citedby><cites>FETCH-LOGICAL-c4591-d3a95602809b2a61a11579d7ca46a834908c8434e233316034ca20ee80a11f83</cites><orcidid>0000-0001-6999-4195 ; 0000-0002-3561-215X ; 0000-0002-3531-8241 ; 0000-0003-0346-716X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fcncr.33471$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fcncr.33471$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,782,786,1419,1435,27931,27932,39265,45581,45582,46416,46840</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33631040$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kiong, Kimberley L.</creatorcontrib><creatorcontrib>Yao, Christopher M. K. L.</creatorcontrib><creatorcontrib>Lin, Fang‐Yu</creatorcontrib><creatorcontrib>Bell, Diana</creatorcontrib><creatorcontrib>Ferrarotto, Renata</creatorcontrib><creatorcontrib>Weber, Randal S.</creatorcontrib><creatorcontrib>Lewis, Carol M.</creatorcontrib><title>Delay to surgery after neoadjuvant chemotherapy in head and neck squamous cell carcinoma affects oncologic outcomes</title><title>Cancer</title><addtitle>CANCER-AM CANCER SOC</addtitle><addtitle>Cancer</addtitle><description>Background
Neoadjuvant chemotherapy (NAC) is used in head and neck squamous cell carcinoma (HNSCC) for downstaging advanced disease and decreasing distant metastasis (DM). To the authors' knowledge, no study has specifically examined the impact of a delayed time to surgery (TTS) after NAC on oncologic outcomes. They thus aimed to identify a cutoff for TTS after NAC and its effect on survival indices.
Methods
This was a retrospective review of all patients with HNSCC receiving NAC followed by surgery with curative intent between March 2016 and March 2019 at the MD Anderson Cancer Center. Receiver operating characteristic analysis was used to identify a cutoff for TTS, and this cutoff was used to analyze the overall survival (OS), locoregional recurrence rate, DM‐free rate, and disease‐free survival (DFS). A multivariate Cox regression analysis was performed.
Results
One hundred one patients were analyzed with a median follow‐up of 24.7 months. The 3‐year OS and locoregional recurrence rates did not differ with a TTS ≥ 34 days. However, the 3‐year DM‐free rate was significantly worse (56% vs 90%; P = .001) in the group with a TTS ≥ 34 days, and the 3‐year DFS was significantly lower (26% vs 64%; P = .006). In a multivariate analysis, a TTS ≥ 34 days (hazard ratio [HR], 4.92; 95% confidence interval [CI], 1.84‐13.13) and extracapsular extension (HR, 3.01; 95% CI, 1.13‐8.00) were significant independent predictors of a poorer DM‐free rate. Weight loss > 10% (HR, 5.53; 95% CI, 1.02‐30.24) was the only independent predictor for a TTS ≥ 34 days.
Conclusions
Emphasis should be placed on early definitive locoregional treatment after NAC, particularly in patients who do not respond to NAC. There is a need to validate these findings and establish new benchmarks for the interval between NAC and surgery.
A delay to surgery after neoadjuvant chemotherapy for head and neck squamous cell carcinoma results in a higher distant metastasis rate and poorer disease‐free survival.</description><subject>Benchmarks</subject><subject>Cancer</subject><subject>Chemotherapy</subject><subject>Confidence intervals</subject><subject>Disease-Free Survival</subject><subject>Head & neck cancer</subject><subject>head and neck neoplasms</subject><subject>Head and Neck Neoplasms - drug therapy</subject><subject>Head and Neck Neoplasms - surgery</subject><subject>Humans</subject><subject>Life Sciences & Biomedicine</subject><subject>Metastases</subject><subject>Multivariate analysis</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Oncology</subject><subject>Patients</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Science & Technology</subject><subject>Squamous cell carcinoma</subject><subject>Squamous Cell Carcinoma of Head and Neck - drug therapy</subject><subject>Squamous Cell Carcinoma of Head and Neck - surgery</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Survival</subject><subject>Weight loss</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>HGBXW</sourceid><sourceid>EIF</sourceid><recordid>eNqN0UuLFDEQB_AgijuuXvwAEvAiK7NWHv3IUdr1AYuC7MFbU5Ou3umxO5lNOkp_ezPOuAcP4ikJ_FL8q4qx5wIuBYB8Y50Nl0rpSjxgKwGmWoPQ8iFbAUC9LrT6dsaexLjLz0oW6jE7U6pUAjSsWHxHIy589jymcEth4djPFLgjj90u_UA3c7ulyc9bCrhf-OD4lrDj6LqM7Hce7xJOPkVuaRy5xWAH5yfMdXqyc-TeWT_628Fyn2brJ4pP2aMex0jPTuc5u3l_ddN8XF9_-fCpeXu9trowYt0pNEUJsgazkVgKFKKoTFdZ1CXWShuoba2VJqmUEiUobVECUQ1Z9rU6Z6-OZffB3yWKczsN8RASc3MptlIbLY0yYDJ9-Rfd-RRcDtfmgQklZVlDVhdHZYOPMVDf7sMwYVhaAe1hE-1hE-3vTWT84lQybSbq7umf0WdQH8FP2vg-2oGcpXuWd1XK3C-U-QaiGWacB-8an9ycv77-_69Zi5MeRlr-kbltPjdfj-l_AVEJs6I</recordid><startdate>20210615</startdate><enddate>20210615</enddate><creator>Kiong, Kimberley L.</creator><creator>Yao, Christopher M. K. L.</creator><creator>Lin, Fang‐Yu</creator><creator>Bell, Diana</creator><creator>Ferrarotto, Renata</creator><creator>Weber, Randal S.</creator><creator>Lewis, Carol M.</creator><general>Wiley</general><general>Wiley Subscription Services, Inc</general><scope>BLEPL</scope><scope>DTL</scope><scope>HGBXW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6999-4195</orcidid><orcidid>https://orcid.org/0000-0002-3561-215X</orcidid><orcidid>https://orcid.org/0000-0002-3531-8241</orcidid><orcidid>https://orcid.org/0000-0003-0346-716X</orcidid></search><sort><creationdate>20210615</creationdate><title>Delay to surgery after neoadjuvant chemotherapy in head and neck squamous cell carcinoma affects oncologic outcomes</title><author>Kiong, Kimberley L. ; Yao, Christopher M. K. L. ; Lin, Fang‐Yu ; Bell, Diana ; Ferrarotto, Renata ; Weber, Randal S. ; Lewis, Carol M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4591-d3a95602809b2a61a11579d7ca46a834908c8434e233316034ca20ee80a11f83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Benchmarks</topic><topic>Cancer</topic><topic>Chemotherapy</topic><topic>Confidence intervals</topic><topic>Disease-Free Survival</topic><topic>Head & neck cancer</topic><topic>head and neck neoplasms</topic><topic>Head and Neck Neoplasms - drug therapy</topic><topic>Head and Neck Neoplasms - surgery</topic><topic>Humans</topic><topic>Life Sciences & Biomedicine</topic><topic>Metastases</topic><topic>Multivariate analysis</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Oncology</topic><topic>Patients</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Science & Technology</topic><topic>Squamous cell carcinoma</topic><topic>Squamous Cell Carcinoma of Head and Neck - drug therapy</topic><topic>Squamous Cell Carcinoma of Head and Neck - surgery</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Survival</topic><topic>Weight loss</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kiong, Kimberley L.</creatorcontrib><creatorcontrib>Yao, Christopher M. K. L.</creatorcontrib><creatorcontrib>Lin, Fang‐Yu</creatorcontrib><creatorcontrib>Bell, Diana</creatorcontrib><creatorcontrib>Ferrarotto, Renata</creatorcontrib><creatorcontrib>Weber, Randal S.</creatorcontrib><creatorcontrib>Lewis, Carol M.</creatorcontrib><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Web of Science - Science Citation Index Expanded - 2021</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kiong, Kimberley L.</au><au>Yao, Christopher M. K. L.</au><au>Lin, Fang‐Yu</au><au>Bell, Diana</au><au>Ferrarotto, Renata</au><au>Weber, Randal S.</au><au>Lewis, Carol M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Delay to surgery after neoadjuvant chemotherapy in head and neck squamous cell carcinoma affects oncologic outcomes</atitle><jtitle>Cancer</jtitle><stitle>CANCER-AM CANCER SOC</stitle><addtitle>Cancer</addtitle><date>2021-06-15</date><risdate>2021</risdate><volume>127</volume><issue>12</issue><spage>1984</spage><epage>1992</epage><pages>1984-1992</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><abstract>Background
Neoadjuvant chemotherapy (NAC) is used in head and neck squamous cell carcinoma (HNSCC) for downstaging advanced disease and decreasing distant metastasis (DM). To the authors' knowledge, no study has specifically examined the impact of a delayed time to surgery (TTS) after NAC on oncologic outcomes. They thus aimed to identify a cutoff for TTS after NAC and its effect on survival indices.
Methods
This was a retrospective review of all patients with HNSCC receiving NAC followed by surgery with curative intent between March 2016 and March 2019 at the MD Anderson Cancer Center. Receiver operating characteristic analysis was used to identify a cutoff for TTS, and this cutoff was used to analyze the overall survival (OS), locoregional recurrence rate, DM‐free rate, and disease‐free survival (DFS). A multivariate Cox regression analysis was performed.
Results
One hundred one patients were analyzed with a median follow‐up of 24.7 months. The 3‐year OS and locoregional recurrence rates did not differ with a TTS ≥ 34 days. However, the 3‐year DM‐free rate was significantly worse (56% vs 90%; P = .001) in the group with a TTS ≥ 34 days, and the 3‐year DFS was significantly lower (26% vs 64%; P = .006). In a multivariate analysis, a TTS ≥ 34 days (hazard ratio [HR], 4.92; 95% confidence interval [CI], 1.84‐13.13) and extracapsular extension (HR, 3.01; 95% CI, 1.13‐8.00) were significant independent predictors of a poorer DM‐free rate. Weight loss > 10% (HR, 5.53; 95% CI, 1.02‐30.24) was the only independent predictor for a TTS ≥ 34 days.
Conclusions
Emphasis should be placed on early definitive locoregional treatment after NAC, particularly in patients who do not respond to NAC. There is a need to validate these findings and establish new benchmarks for the interval between NAC and surgery.
A delay to surgery after neoadjuvant chemotherapy for head and neck squamous cell carcinoma results in a higher distant metastasis rate and poorer disease‐free survival.</abstract><cop>HOBOKEN</cop><pub>Wiley</pub><pmid>33631040</pmid><doi>10.1002/cncr.33471</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-6999-4195</orcidid><orcidid>https://orcid.org/0000-0002-3561-215X</orcidid><orcidid>https://orcid.org/0000-0002-3531-8241</orcidid><orcidid>https://orcid.org/0000-0003-0346-716X</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Benchmarks Cancer Chemotherapy Confidence intervals Disease-Free Survival Head & neck cancer head and neck neoplasms Head and Neck Neoplasms - drug therapy Head and Neck Neoplasms - surgery Humans Life Sciences & Biomedicine Metastases Multivariate analysis Neoadjuvant Therapy Neoplasm Recurrence, Local - pathology Oncology Patients Regression analysis Retrospective Studies Science & Technology Squamous cell carcinoma Squamous Cell Carcinoma of Head and Neck - drug therapy Squamous Cell Carcinoma of Head and Neck - surgery Statistical analysis Surgery Survival Weight loss |
| title | Delay to surgery after neoadjuvant chemotherapy in head and neck squamous cell carcinoma affects oncologic outcomes |
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