Neoadjuvant chemoimmunotherapy brings superior quality of life of patients with locally advanced oral or oropharyngeal cancer: A propensity score-matched analysis.

BACKGROUND: The outcomes and quality of life of patients with locally advanced oral or oropharyngeal squamous cell carcinoma (LAOOPSCC) following upfront surgery (US) are suboptimal. The optimal neoadjuvant therapy involving programmed death-1 inhibitors still remains unknown. We aimed to investigate the antitumor efficacy and quality-of-life benefits of neoadjuvant chemoimmunotherapy (NACI) and compare them with those of US for LAOOPSCC. METHODS: A total of 570 patients with OOPSCC who underwent surgical treatment between January 2021 and January 2023 were initially reviewed and we obtained 51 unbiased patients in each of the NACI and US groups through propensity score matching based on age, sex, clinical T and N stage. The antitumor efficacy in patients in the NACI group was evaluated with the pathological response. The postoperative quality of life, as assessed with the EORTC Quality of Life Questionnaire Head and Neck 35, as well as disease-free survival and overall survival, were compared between the groups. RESULTS: In the NACI group, the major pathological response rate was 58.8 % (30/51), and the objective response rate was 66.7 % (34/51). In NACI group, In the NACI group, patients experienced a shorter operative time (p = 0.001) and a reduced length of hospitalization post-surgery (p = 0.041), along with less intraoperative blood loss (p < 0.001) and fewer free flap reconstructions (p < 0.001). Compared with the patients in the US group, those in the NACI group had significantly better postoperative quality of life, including the sensory function (12.7 vs. 23.0, p = 0.021), speech problems (17.3 vs. 35.1, p < 0.001), social eating (20.8 vs. 31.0, p = 0.020), social contact (19.8 vs. 36.5, p < 0.001) and feeling ill (41.2 vs. 51.6, p = 0.021). There was no significant statistical difference in OS (p = 0.825) and DFS (p = 0.473) between the two groups. CONCLUSION: The findings demonstrate the safety and feasibility of NACI and the de-escalation surgery after NACI is worth promoting to improve patient postoperative quality of life.