PATH classification: a proposal for patients with HNSCC treated with salvage surgery

Area of Science:

• Oncology
• Surgical Pathology
• Cancer Staging

Background:

• Recurrent head and neck squamous cell carcinoma (HNSCC) presents a significant clinical challenge.
• Salvage surgery is a critical treatment option for patients with recurrent HNSCC.
• Accurate prognostic classification is essential for guiding treatment decisions and patient counseling.

Purpose of the Study:

• To propose a novel postoperative classification system for recurrent HNSCC patients undergoing salvage surgery.
• To evaluate the prognostic capacity of the proposed classification compared to the current rpTNM system.

Main Methods:

• Retrospective analysis of 665 patients with HNSCC treated with salvage surgery for local and/or regional recurrence.
• Development of the PATH (Primary tumor location, Pathologic extension, Tumor margins, and Extracapsular spread) classification.
• Comparison of prognostic discrimination between the PATH classification and the rpTNM classification.

Main Results:

• The PATH classification stratifies patients into 4 stages based on primary tumor site, pathologic extension, margin status, and lymph node extracapsular spread.
• The PATH classification demonstrated more homogeneous prognosis within stages and superior prognostic discrimination compared to rpTNM.
• Five-year disease-specific survival rates varied significantly across PATH stages (82.8% for PATH I to 3.7% for PATH IV), outperforming rpTNM staging.

Conclusions:

• The proposed PATH classification offers a more accurate prognostic tool for recurrent HNSCC patients undergoing salvage surgery.
• This new system provides better prognostic stratification and discrimination than the rpTNM classification.
• The PATH classification can aid in optimizing treatment strategies and predicting outcomes for this patient population.