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Objective <p>This study primarily aimed to identify prognostic factors for patients with recurrent/metastatic tongue squamous cell carcinoma (R/M TSCC) undergoing re-resection and to preliminarily explore the value of baseline metabolic parameters in predicting pathological response after neoadjuvant therapy (NAT).</p> Materials and methods <p>In the primary analyses, we analyzed 114 patients with R/M TSCC who underwent direct re-resection or re-resection after NAT between 2017 and 2024. Clinical, pathological, and PET/CT parameters were collected. Lasso-Cox regression was performed to identify factors influencing disease-free survival (DFS) and overall survival (OS), with internal validation via bootstrapping with 1000 resamples. Sensitivity analysis was performed to test the robustness of the main findings by restricting the analysis to the 100 patients who underwent elective neck dissection (a subgroup of the 114 patients). Patients undergoing re-resection after NAT were grouped by pathological response (pCR/MPR vs. non-MPR) for comparison.</p> Results <p>Median follow-up was 43.0 months (110 were evaluable), with 53 deaths and 46 remaining recurrence-free. Initial pathological N status and differentiation at recurrence were prognostic factors for both DFS and OS, with HRs of 2.29 (95% CI: 1.40–3.77, <i>P</i> = 0.001), 2.62 (95% CI: 1.48–4.62, <i>P</i> &lt; 0.001), 2.75 (95% CI: 1.57–4.80, <i>P</i> &lt; 0.001), and 2.87 (95% CI: 1.47–5.61, <i>P</i> = 0.002), respectively. The robustness of initial pathological N status for OS, differentiation at recurrence for both DFS and OS were testified by sensitivity analyses. Among the 26 patients who underwent re-resection after NAT, the pCR/MPR group showed higher SULmax (<i>P</i> = 0.033) and SUR (<i>P</i> = 0.041) and had longer DFS (<i>P</i> = 0.045) than the non-MPR group, while no significant difference in OS was observed between the two subgroups.</p> Conclusions <p>Initial pN positivity is associated with worse OS, and moderate to low differentiation at recurrence might be associated with worse DFS and OS in R/M TSCC patients undergoing re-resection. Baseline metabolic parameters might have the potential to identify pathological response after NAT.</p> Clinical relevance <p>Identifying risk factors for survival in R/M TSCC patients treated with re-resection is crucial for tailoring postoperative strategies.</p>

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Initial pN and differentiation at recurrence as prognostic factors in patients with recurrent or metastatic tongue squamous cell carcinoma undergoing re-resection

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月20日

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  • Xiaohuang Yang,
  • Hui Ye,
  • Hui Cao,
  • Wu Li,
  • Kai Zheng,
  • Xiaoping Yu

摘要

Objective

This study primarily aimed to identify prognostic factors for patients with recurrent/metastatic tongue squamous cell carcinoma (R/M TSCC) undergoing re-resection and to preliminarily explore the value of baseline metabolic parameters in predicting pathological response after neoadjuvant therapy (NAT).

Materials and methods

In the primary analyses, we analyzed 114 patients with R/M TSCC who underwent direct re-resection or re-resection after NAT between 2017 and 2024. Clinical, pathological, and PET/CT parameters were collected. Lasso-Cox regression was performed to identify factors influencing disease-free survival (DFS) and overall survival (OS), with internal validation via bootstrapping with 1000 resamples. Sensitivity analysis was performed to test the robustness of the main findings by restricting the analysis to the 100 patients who underwent elective neck dissection (a subgroup of the 114 patients). Patients undergoing re-resection after NAT were grouped by pathological response (pCR/MPR vs. non-MPR) for comparison.

Results

Median follow-up was 43.0 months (110 were evaluable), with 53 deaths and 46 remaining recurrence-free. Initial pathological N status and differentiation at recurrence were prognostic factors for both DFS and OS, with HRs of 2.29 (95% CI: 1.40–3.77, P = 0.001), 2.62 (95% CI: 1.48–4.62, P < 0.001), 2.75 (95% CI: 1.57–4.80, P < 0.001), and 2.87 (95% CI: 1.47–5.61, P = 0.002), respectively. The robustness of initial pathological N status for OS, differentiation at recurrence for both DFS and OS were testified by sensitivity analyses. Among the 26 patients who underwent re-resection after NAT, the pCR/MPR group showed higher SULmax (P = 0.033) and SUR (P = 0.041) and had longer DFS (P = 0.045) than the non-MPR group, while no significant difference in OS was observed between the two subgroups.

Conclusions

Initial pN positivity is associated with worse OS, and moderate to low differentiation at recurrence might be associated with worse DFS and OS in R/M TSCC patients undergoing re-resection. Baseline metabolic parameters might have the potential to identify pathological response after NAT.

Clinical relevance

Identifying risk factors for survival in R/M TSCC patients treated with re-resection is crucial for tailoring postoperative strategies.