Survival Rates for Patients With Squamous Cell Carcinoma Identified in New Study

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Findings showed that alternative to conventional follow-up resulted in a higher 3-year overall survival rate.

Patients with head and neck squamous cell carcinoma (HNSCC) who were clinically asymptomatic had a higher survival rate when follow-up included 18F-fludeoxyglucose–positron emission tomography with computed tomography (18FDG-PET/CT) than those patients who received conventional follow-up.1 The case-control study in France followed adults who had histologically proven HNSCC treated with curative intent between January 1, 2006, and December 31, 2019, and achieved a complete response on imaging at 3 to 6 months.

Researchers reviewed cases of 782 patients (642 males) with a median age of 61 years. Conventional follow-up (CFU group) was used in 285 cases and 18FDG-PET/CT was used in 497 cases. Patients were followed for at least 3 years and the main outcome measure was overall survival (OS) at 3 years.

Treatment was balanced with 391 patients receiving radiotherapy and 391 patients having surgery. Surveillance lung imaging was performed at 12, 24, and 36 months post-treatment with a chest CT (computed tomography [CFU group]) or using 18FDG-PET/CT. A total of 47 patients were lost to follow-up at 3 years.

Among the 18FDG-PET/CT group, several clinical characteristics at diagnosis were significantly worse than the CFU group, including having a higher rate of cancer history (24.7% vs 13.3%; P = .002), a higher number of patients with immunodeficiency (8.7% vs 3.2%; P = .003), a lower number of patients with a performance status score of 0 (58.1% vs 73%; P < .001), a higher rate of alcohol consumption (39% vs 26.7%; P < .001), and more patients with an advanced stage (75.1% vs 63.2%; P < .001).

“Regardless of the treatment received, 123 of 164 recurrences (75.0%) occurred within 660 days after treatment.”1 In the 18FDG-PET/CT group, 111 relapses (22.3%) occurred. “The overall detection rate of subclinical recurrence by 18FDG-PET/CT was 62 patients (12.4%). Of the total subclinical recurrences, 36 recurrences (58.1%), 19 recurrences (30.6%), and 7 recurrences (11.3%) were detected by 18FDG-PET/CT,” at months 12, 24, and 36, respectively, among patients that were clinically asymptomatic.

The survival rate in the 18FDG-PET/CT group was significantly higher than in the CFU group, at 72.5% compared to 64.3%, P = .002, regardless of the stage at diagnosis. “Cox regression analysis showed an association between undergoing 18FDG-PET/CT and lower risk of death (odds ratio, 0.71; 95% CI, 0.57-0.88; P = .002) compared with CFU after adjustment for covariates (age, sex, comorbidities, primary location, stage, surgeon, year of treatment, and treatment).”1

In the 164 patients with recurrent disease, 3-year OS was significantly higher in the 18FDG-PET/CT group compared to the CFU group.

There was no difference between groups in mean 3-year OS when diagnosed at stage I or II. However, when diagnosed at stage III or IV, the 18FDG-PET/CT group (n = 373) had a longer mean 3-year OS (n = 180; 68.5% vs 55.4%; P < .001, respectively) than the CFU group.

The 18FDG-PET/CT group (n = 176) also had a significantly longer mean OS than the CFU group (n = 100) for oropharyngeal tumors. In oral cavity, laryngeal, and hypopharyngeal tumors, there was no significant difference in mean OS.

The findings showed that 18FDG-PET/CT resulted in a higher 3-year OS than CFU, particularly in patients with disease stage III to IV or oropharyngeal tumors.

This article originally appeared on Dermatology Times.

Reference
1. Leclère J, Clément C, Le Pennec R, et al. An intensive 18F-Fludeoxyglucose–Positron Emission Tomography with computed tomography–based strategy of follow-up in patients treated for head and neck squamous cell carcinoma who are clinically asymptomatic. JAMA Netw Open. 2023;6(8):e2326654. doi:10.1001/jamanetworkopen.2023.26654
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