Williamson Andrew, Lim Alison E, Green Freddie, Lee Ying Ki, Li Lucy, Moen Christy, Vasanthan Rishi, Wharf Olivia, Wong Jeremy, Paleri Vinidh
Head and Neck Unit, The Royal Marsden Hospital, London, UK.
International Centre for Recurrent Head and Neck Cancer (IReC), The Royal Marsden Hospital, London, UK.
Head Neck. 2025 May;47(5):1399-1410. doi: 10.1002/hed.28045. Epub 2024 Dec 27.
To investigate the management of recurrent head and neck squamous cell carcinoma (rHNSCC) and describe survival outcomes.
Post hoc subgroup analysis of a retrospective national observational cohort was conducted. All patients with rHNSCC who received a definitive treatment decision between September 1, 2021 and November 30, 2021 were included. Survival analysis was stratified according to subsite, primary versus recurrent disease, and surgical versus nonsurgical treatment.
Data from 202 rHNSCC patients were derived from a cohort of 1488 patients submitted by 50 UK centers. Median age was 66 years (IQR 58-74), and 142 (70.3%) were male. The most common recurrence subsites were oropharynx (20.5%), oral cavity (19.5%), larynx (16.4%), and hypopharynx (14.9%). Ninety-three (48.4%) were managed curatively. Surgery was the most common treatment for laryngeal (59.4%), oral cavity (60.5%), hypopharyngeal (44.8%), and oropharyngeal (37.5%) cancers. Two-year overall (OS), disease-free (DFS), disease-specific (DSS), and local recurrence free survival (LRFS) were 41.1%, 39.1%, 42.2%, and 39.3%, respectively. rHNSCC treated with surgery had improved OS (p = 0.0005), DFS (p = 0.012), DSS (p = 0.0003), and LRFS (p = 0.007), over nonsurgical treatments. Compared to primary cancers, rHNSCC presents with more advanced T stage (p < 0.001) and distant metastasis (p < 0.001), receives less curative treatment (p < 0.001), and has worse survival outcomes (all p < 0.001). On multivariate analysis, salvage surgery, radiotherapy, and p16 status were independent prognostic factors of all survival outcomes.
Recurrent HNSCC is associated with high rates of incurable disease and worse survival than primary cancers. Surgery remains the most common curative treatment in rHNSCC, however future studies are necessary to improve patient selection and optimize outcomes following salvage treatment.
探讨复发性头颈部鳞状细胞癌（rHNSCC）的管理并描述生存结果。
对一项回顾性全国观察性队列进行事后亚组分析。纳入2021年9月1日至2021年11月30日期间接受明确治疗决策的所有rHNSCC患者。根据亚部位、原发性疾病与复发性疾病以及手术治疗与非手术治疗进行生存分析。
202例rHNSCC患者的数据来自英国50个中心提交的1488例患者队列。中位年龄为66岁（四分位间距58 - 74岁），142例（70.3%）为男性。最常见的复发亚部位为口咽（20.5%）、口腔（19.5%）、喉（16.4%）和下咽（14.9%）。93例（48.4%）接受了根治性治疗。手术是喉癌（59.4%）、口腔癌（60.5%）、下咽癌（44.8%）和口咽癌（37.5%）最常见的治疗方法。两年总生存率（OS）、无病生存率（DFS）、疾病特异性生存率（DSS）和无局部复发生存率（LRFS）分别为41.1%、39.1%、42.2%和39.3%。与非手术治疗相比，手术治疗的rHNSCC患者的OS（p = 0.0005）、DFS（p = 0.012）、DSS（p = 0.0003）和LRFS（p = 0.007）均有所改善。与原发性癌症相比，rHNSCC的T分期更晚（p < 0.001）且远处转移更多（p < 0.001），接受根治性治疗的比例更低（p < 0.001），生存结果更差（所有p < 0.001）。多因素分析显示，挽救性手术、放疗和p16状态是所有生存结果的独立预后因素。
复发性HNSCC与高比例的不可治愈疾病相关，且生存情况比原发性癌症更差。手术仍然是rHNSCC最常见的根治性治疗方法，然而未来有必要开展研究以改善患者选择并优化挽救性治疗后的结局。
