Prognostic significance and predictors of pathological response following neoadjuvant paclitaxel, carboplatin, and cetuximab therapy in head and neck squamous cell carcinoma

INTRODUCTION: Neoadjuvant chemotherapy using paclitaxel, carboplatin, and cetuximab (PCE-NAC) is used in patients with locally advanced head and neck squamous cell carcinoma (HNSCC); however, predictors of survival outcome remain unclear. This study aimed to evaluate the prognostic value of the pathological response to PCE-NAC and identify clinical factors associated with a favorable pathological response. MATERIALS AND METHODS: We retrospectively reviewed 59 patients with HNSCC who underwent PCE-NAC followed by surgery at our institution. Pathological response was assessed according to the General Rules for Clinical and Pathological Studies on Head and Neck Cancer in Japan and categorized as favorable pathological response (≥ Grade 2, less than one-third of cancer cells are viable). Recurrence-free survival (RFS) was analyzed using Kaplan-Meier and Cox proportional hazard analyses. Logistic regression analysis was performed to identify the predictors of favorable pathological response. RESULTS: A favorable pathological response (≥ Grade 2) was obtained in 42.4 % of patients, which was significantly associated with better 2-year RFS (80.1 % vs. 62.7 %, p = 0.032). In contrast, pathological complete response and radiological response (complete or partial response) were not significantly associated with prognosis. Multivariable logistic regression analysis determined that younger age and female sex were associated with a favorable pathological response. CONCLUSIONS: Pathological response beyond pCR may provide clinically meaningful information on treatment efficacy following PCE-NAC. Younger age and female sex were associated with a favorable pathological response, suggesting their potential relevance to treatment response.