Survival benefits from surgery for stage iva head and neck squamous cell carcinoma: A multi-institutional analysis of 1,033 cases

Jun Ook Park, Young Min Park, Woo Jin Jeong, Yoo Seob Shin, Yong Tae Hong, Ik Joon Choi, Ji Won Kim, Seung Hoon Woo, Yeon Soo Kim, Jae Won Chang, Min Sik Kim, Kwang Yoon Jung, Soon Hyun Ahn, Chul Ho Kim, Ki Hwan Hong, Phil Sang Chung, Young Mo Kim, Se Heon Kim, Seung Kuk Baek

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Objectives. Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and dis-ease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/with-out (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). Methods. We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. Results. Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. 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, respectively. 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 [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In sub-group 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). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyn-geal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780). 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 hypopharyn-geal cancer.

Original languageEnglish
Pages (from-to)225-234
Number of pages10
JournalClinical and Experimental Otorhinolaryngology
Issue number2
Publication statusPublished - 2021
Externally publishedYes


  • Hypopharyn-geal Neoplasms
  • Laryngeal Neoplasms
  • Oral Neoplasms
  • Oropharyngeal Neoplasm
  • Prognosis
  • Squamous Cell Carcinoma of Head And Neck
  • Surgery
  • Survival Rate
  • Survival, Disease-Free Survival

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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