He Xiaotong, Lei Xiaoyue, Cheng Yangxi, Zhu Huiyong
Department of Oral Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Clinical Research Center for Oral Diseases of Zhejiang Province, Hangzhou, China.
Adv Clin Exp Med. 2025 Aug;34(8):1307-1319. doi: 10.17219/acem/192623.
Oral squamous cell carcinoma (OSCC) is one of the most common cancers in humans. The role of neoadjuvant chemotherapy (NAC) in OSCC remains controversial.
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.
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).
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.
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.
口腔鳞状细胞癌（OSCC）是人类最常见的癌症之一。新辅助化疗（NAC）在OSCC中的作用仍存在争议。
本研究旨在探讨NAC对局部晚期OSCC的疗效，并确定不同治疗方法中的预后因素，以最终指导未来治疗的最佳选择。
共纳入156例局部晚期OSCC患者。比较接受和未接受NAC患者的临床特征和生存结果。主要终点为总生存期（OS），次要终点为无病生存期（DFS）。
在本研究纳入的156例患者中，81例患者接受NAC后手术，75例患者仅接受手术。3年时OS未检测到显著差异（78.3%对79.8%，p = （此处原文有误，推测为p = 0.76））。然而，NAC组的DFS明显更差（42.4%对59.2%，p = 0.048）。在NAC组中，50例患者（61.7%）有良好的临床反应，12例患者（14.8%）有完全病理反应。有良好临床反应的患者生存结果更好。在分层分析中，NAC后pT3/4 OSCC患者的DFS比单独接受手术的同阶段患者更差（40.2%对58%，p = 0.033）。在Cox回归中，临床反应和病理分期是NAC组生存的预测因素，而病理分期是手术组OS的唯一预测因素。
NAC后病理分期较晚的患者治疗失败风险可能更高，在当前临床实践中，建议局部晚期OSCC患者直接进行手术。
