High-risk pathological features at the time of salvage surgery predict poor survival after definitive therapy in patients with head and neck squamous cell carcinoma
•Relapse free survival (RFS) and overall survival (OS) were assessed after salvage surgey in HNSCC.•Patients with early relapse after initial therapy (
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| Veröffentlicht in: | Oral oncology 2019-01, Vol.88, p.9-15 |
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| creator | Haque, Sulsal Karivedu, Vidhya Riaz, Muhammed K. Choi, David Roof, Logan Hassan, Sarah Z. Zhu, Zheng Jandarov, Roman Takiar, Vinita Tang, Alice Wise-Draper, Trisha |
| description | •Relapse free survival (RFS) and overall survival (OS) were assessed after salvage surgey in HNSCC.•Patients with early relapse after initial therapy ( |
| doi_str_mv | 10.1016/j.oraloncology.2018.11.010 |
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Salvage surgical resection is the preferred treatment for head and neck squamous cell carcinoma (HNSCC) patients who develop locally recurrent disease after failing primary therapy. However, salvage surgical resection is not always feasible, and survival outcomes for those that do undergo salvage remain poor. It is well known that patients with adverse pathological features (extracapsular extension (ECE) of lymph nodes (LN), positive margins, perineural invasion (PNI), lymphovascular invasion (LVI), and multiple LN metastases) at the time of primary surgical resection are likely to have relatively poor outcomes. However, the impact of adverse pathological features on outcomes in the salvage setting remains controversial.
We retrospectively analyzed 73 patients at a single institution from 2008 to 2017 who developed recurrence and subsequently underwent salvage surgery (SS) after definitive curative-intent therapy including radiation. Demographic and disease control outcomes were reviewed. Kaplan-Meier curves were used to estimate relapse free survival (RFS) and overall survival (OS).
Median age at diagnosis was 61 years (range 40–86), 49/73 (67%) were male, and 55/73 (75%) had smoked. Patients with any adverse pathological features at SS had worse RFS (HR 3.15 p = 0.0008) and worse OS (3.97 p = 0.0008). Patients who relapsed <6 months after initial therapy had worse OS (HR 2.96 p = 0.004).
Patients with adverse pathological features at time of salvage surgery as well as those who have an early recurrence after definitive treatment and salvage surgery have worse outcomes. Prospective studies are necessary to clarify which patients should receive more intense treatment at salvage.</description><identifier>ISSN: 1368-8375</identifier><identifier>EISSN: 1879-0593</identifier><identifier>DOI: 10.1016/j.oraloncology.2018.11.010</identifier><identifier>PMID: 30616803</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Disease-Free Survival ; Female ; Head and neck cancer ; Head and Neck Neoplasms - mortality ; Head and Neck Neoplasms - pathology ; Head and Neck Neoplasms - surgery ; HNSCC ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Male ; Middle Aged ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Salvage surgery ; Salvage Therapy - methods ; Squamous Cell Carcinoma of Head and Neck - mortality ; Squamous Cell Carcinoma of Head and Neck - pathology ; Squamous Cell Carcinoma of Head and Neck - surgery ; Survival Rate</subject><ispartof>Oral oncology, 2019-01, Vol.88, p.9-15</ispartof><rights>2018 Elsevier Ltd</rights><rights>Copyright © 2018 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c487t-26f55e3d69c9247d30aa6a372b37cb4affcee2a1e33c79a32eb36ed5290ad6d3</citedby><cites>FETCH-LOGICAL-c487t-26f55e3d69c9247d30aa6a372b37cb4affcee2a1e33c79a32eb36ed5290ad6d3</cites><orcidid>0000-0001-5720-1813 ; 0000-0002-1145-621X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1368837518304202$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30616803$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Haque, Sulsal</creatorcontrib><creatorcontrib>Karivedu, Vidhya</creatorcontrib><creatorcontrib>Riaz, Muhammed K.</creatorcontrib><creatorcontrib>Choi, David</creatorcontrib><creatorcontrib>Roof, Logan</creatorcontrib><creatorcontrib>Hassan, Sarah Z.</creatorcontrib><creatorcontrib>Zhu, Zheng</creatorcontrib><creatorcontrib>Jandarov, Roman</creatorcontrib><creatorcontrib>Takiar, Vinita</creatorcontrib><creatorcontrib>Tang, Alice</creatorcontrib><creatorcontrib>Wise-Draper, Trisha</creatorcontrib><title>High-risk pathological features at the time of salvage surgery predict poor survival after definitive therapy in patients with head and neck squamous cell carcinoma</title><title>Oral oncology</title><addtitle>Oral Oncol</addtitle><description>•Relapse free survival (RFS) and overall survival (OS) were assessed after salvage surgey in HNSCC.•Patients with early relapse after initial therapy (<6 months) had worse OS.•Patients with adverse pathological features at salvage surgery had worse RFS and OS.•Patients who had no adverse features on pathology did exceptionally well.
Salvage surgical resection is the preferred treatment for head and neck squamous cell carcinoma (HNSCC) patients who develop locally recurrent disease after failing primary therapy. However, salvage surgical resection is not always feasible, and survival outcomes for those that do undergo salvage remain poor. It is well known that patients with adverse pathological features (extracapsular extension (ECE) of lymph nodes (LN), positive margins, perineural invasion (PNI), lymphovascular invasion (LVI), and multiple LN metastases) at the time of primary surgical resection are likely to have relatively poor outcomes. However, the impact of adverse pathological features on outcomes in the salvage setting remains controversial.
We retrospectively analyzed 73 patients at a single institution from 2008 to 2017 who developed recurrence and subsequently underwent salvage surgery (SS) after definitive curative-intent therapy including radiation. Demographic and disease control outcomes were reviewed. Kaplan-Meier curves were used to estimate relapse free survival (RFS) and overall survival (OS).
Median age at diagnosis was 61 years (range 40–86), 49/73 (67%) were male, and 55/73 (75%) had smoked. Patients with any adverse pathological features at SS had worse RFS (HR 3.15 p = 0.0008) and worse OS (3.97 p = 0.0008). Patients who relapsed <6 months after initial therapy had worse OS (HR 2.96 p = 0.004).
Patients with adverse pathological features at time of salvage surgery as well as those who have an early recurrence after definitive treatment and salvage surgery have worse outcomes. Prospective studies are necessary to clarify which patients should receive more intense treatment at salvage.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Head and neck cancer</subject><subject>Head and Neck Neoplasms - mortality</subject><subject>Head and Neck Neoplasms - pathology</subject><subject>Head and Neck Neoplasms - surgery</subject><subject>HNSCC</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Salvage surgery</subject><subject>Salvage Therapy - methods</subject><subject>Squamous Cell Carcinoma of Head and Neck - mortality</subject><subject>Squamous Cell Carcinoma of Head and Neck - pathology</subject><subject>Squamous Cell Carcinoma of Head and Neck - surgery</subject><subject>Survival Rate</subject><issn>1368-8375</issn><issn>1879-0593</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkcFu1DAQhiMEoqXwCsjixCXBjjd2wgEJlZYiVeLSuzVrTxJvkzi1naB9Hx4UR1uqcuNky_7n_2fmy7IPjBaMMvHpUDgPg5u0G1x3LErK6oKxgjL6IjtntWxyWjX8ZbpzUec1l9VZ9iaEA6W0YhV9nZ1xKpioKT_Pft_Yrs-9DfdkhthvjlbDQFqEuHgMBCKJPZJoRySuJQGGFTokYfEd-iOZPRqrI5md89vjatdUDW1ETwy2drLRrrhZeJiPxE5bjMUpBvLLxp70CIbAZMiE-p6EhwVGtwSicRiIBq_t5EZ4m71qYQj47vG8yO6ur-4ub_Lbn99_XH69zfWuljEvRVtVyI1odFPupOEUQACX5Z5Lvd9B22rEEhhyrmUDvMQ9F2iqsqFghOEX2ZeT7bzsRzQ6dZn2rGZvR_BH5cCqf38m26vOrUrwUjaCJ4OPjwbePSwYohpt2EaBCdNUqmSiSmik3KSfT1LtXQge26cYRtVGWR3Uc8pqo6wYU4lyKn7_vNGn0r9Yk-DbSYBpW6tFr4JOS9eJlUcdlXH2f3L-ANRDxuo</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Haque, Sulsal</creator><creator>Karivedu, Vidhya</creator><creator>Riaz, Muhammed K.</creator><creator>Choi, David</creator><creator>Roof, Logan</creator><creator>Hassan, Sarah Z.</creator><creator>Zhu, Zheng</creator><creator>Jandarov, Roman</creator><creator>Takiar, Vinita</creator><creator>Tang, Alice</creator><creator>Wise-Draper, Trisha</creator><general>Elsevier Ltd</general><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>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5720-1813</orcidid><orcidid>https://orcid.org/0000-0002-1145-621X</orcidid></search><sort><creationdate>20190101</creationdate><title>High-risk pathological features at the time of salvage surgery predict poor survival after definitive therapy in patients with head and neck squamous cell carcinoma</title><author>Haque, Sulsal ; Karivedu, Vidhya ; Riaz, Muhammed K. ; Choi, David ; Roof, Logan ; Hassan, Sarah Z. ; Zhu, Zheng ; Jandarov, Roman ; Takiar, Vinita ; Tang, Alice ; Wise-Draper, Trisha</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c487t-26f55e3d69c9247d30aa6a372b37cb4affcee2a1e33c79a32eb36ed5290ad6d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Head and neck cancer</topic><topic>Head and Neck Neoplasms - mortality</topic><topic>Head and Neck Neoplasms - pathology</topic><topic>Head and Neck Neoplasms - surgery</topic><topic>HNSCC</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prognosis</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Salvage surgery</topic><topic>Salvage Therapy - methods</topic><topic>Squamous Cell Carcinoma of Head and Neck - mortality</topic><topic>Squamous Cell Carcinoma of Head and Neck - pathology</topic><topic>Squamous Cell Carcinoma of Head and Neck - surgery</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Haque, Sulsal</creatorcontrib><creatorcontrib>Karivedu, Vidhya</creatorcontrib><creatorcontrib>Riaz, Muhammed K.</creatorcontrib><creatorcontrib>Choi, David</creatorcontrib><creatorcontrib>Roof, Logan</creatorcontrib><creatorcontrib>Hassan, Sarah Z.</creatorcontrib><creatorcontrib>Zhu, Zheng</creatorcontrib><creatorcontrib>Jandarov, Roman</creatorcontrib><creatorcontrib>Takiar, Vinita</creatorcontrib><creatorcontrib>Tang, Alice</creatorcontrib><creatorcontrib>Wise-Draper, Trisha</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Oral oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Haque, Sulsal</au><au>Karivedu, Vidhya</au><au>Riaz, Muhammed K.</au><au>Choi, David</au><au>Roof, Logan</au><au>Hassan, Sarah Z.</au><au>Zhu, Zheng</au><au>Jandarov, Roman</au><au>Takiar, Vinita</au><au>Tang, Alice</au><au>Wise-Draper, Trisha</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High-risk pathological features at the time of salvage surgery predict poor survival after definitive therapy in patients with head and neck squamous cell carcinoma</atitle><jtitle>Oral oncology</jtitle><addtitle>Oral Oncol</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>88</volume><spage>9</spage><epage>15</epage><pages>9-15</pages><issn>1368-8375</issn><eissn>1879-0593</eissn><abstract>•Relapse free survival (RFS) and overall survival (OS) were assessed after salvage surgey in HNSCC.•Patients with early relapse after initial therapy (<6 months) had worse OS.•Patients with adverse pathological features at salvage surgery had worse RFS and OS.•Patients who had no adverse features on pathology did exceptionally well.
Salvage surgical resection is the preferred treatment for head and neck squamous cell carcinoma (HNSCC) patients who develop locally recurrent disease after failing primary therapy. However, salvage surgical resection is not always feasible, and survival outcomes for those that do undergo salvage remain poor. It is well known that patients with adverse pathological features (extracapsular extension (ECE) of lymph nodes (LN), positive margins, perineural invasion (PNI), lymphovascular invasion (LVI), and multiple LN metastases) at the time of primary surgical resection are likely to have relatively poor outcomes. However, the impact of adverse pathological features on outcomes in the salvage setting remains controversial.
We retrospectively analyzed 73 patients at a single institution from 2008 to 2017 who developed recurrence and subsequently underwent salvage surgery (SS) after definitive curative-intent therapy including radiation. Demographic and disease control outcomes were reviewed. Kaplan-Meier curves were used to estimate relapse free survival (RFS) and overall survival (OS).
Median age at diagnosis was 61 years (range 40–86), 49/73 (67%) were male, and 55/73 (75%) had smoked. Patients with any adverse pathological features at SS had worse RFS (HR 3.15 p = 0.0008) and worse OS (3.97 p = 0.0008). Patients who relapsed <6 months after initial therapy had worse OS (HR 2.96 p = 0.004).
Patients with adverse pathological features at time of salvage surgery as well as those who have an early recurrence after definitive treatment and salvage surgery have worse outcomes. Prospective studies are necessary to clarify which patients should receive more intense treatment at salvage.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>30616803</pmid><doi>10.1016/j.oraloncology.2018.11.010</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-5720-1813</orcidid><orcidid>https://orcid.org/0000-0002-1145-621X</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Oral oncology, 2019-01, Vol.88, p.9-15 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Aged Aged, 80 and over Disease-Free Survival Female Head and neck cancer Head and Neck Neoplasms - mortality Head and Neck Neoplasms - pathology Head and Neck Neoplasms - surgery HNSCC Humans Kaplan-Meier Estimate Lymphatic Metastasis Male Middle Aged Prognosis Recurrence Retrospective Studies Risk Factors Salvage surgery Salvage Therapy - methods Squamous Cell Carcinoma of Head and Neck - mortality Squamous Cell Carcinoma of Head and Neck - pathology Squamous Cell Carcinoma of Head and Neck - surgery Survival Rate |
| title | High-risk pathological features at the time of salvage surgery predict poor survival after definitive therapy in patients with head and neck squamous cell carcinoma |
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