Survival benefits from surgery of stage IVa head and neck squamous cell carcinoma: A multi-institutional analysis of 1033 cases.

Objectives Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the local-regional advanced stage (stage IVa) but their treatment with upfront surgery vs. definite chemoradiation therapy (CRT) is controversial. The purpose of the present study is to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily with upfront surgery vs. CRT. Methods We reviewed data of 1033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. Result Among 1033 patients, 765 (74.1%) received upfront surgery (surgery group) and 268 (25.9%) received CRT (CRT group). The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [95%CI]: 0.592-0.981; OR for recurrence, 0.628; 95%CI, 0.492-0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95%CI: 0.341-0.879; OR for recurrence, 0.598; 95%CI: 0.377-0.948). For patients with laryngeal cancer, OS was improved in the surgery group (OR for death, 0.432; 95%CI: 0.211-0.882) and for those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95%CI: 0.328-0.780) in the surgery group. Conclusion A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.