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Fuel for Recovery: Predicting G-Tube Dependence in HPV-Negative Operable HNSCC.

Marie-Michelle McNicoll1, Alex M Mlynarek2, Keith Richardson2

  • 1Undergraduate Medical Education, McGill University, Montréal, Quebec, Canada.

Head & Neck
|August 13, 2025
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Summary

A new risk model accurately predicts prolonged gastrostomy tube dependence in head and neck cancer patients. This tool aids preoperative planning for improved patient outcomes.

Keywords:
HNSCCPEG dependencehead and neck cancerrisk stratificationsarcopenia

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Area of Science:

  • Oncology
  • Radiology
  • Surgical Oncology

Background:

  • HPV-negative head and neck squamous cell carcinoma (HNSCC) poses challenges with prolonged gastrostomy tube dependence.
  • Current risk assessment models for HNSCC lack crucial health metrics like sarcopenia.
  • This study aims to develop an improved preoperative risk model for HNSCC patients.

Purpose of the Study:

  • To develop and validate a novel risk prediction model for gastrostomy tube dependence in HPV-negative HNSCC patients.
  • To incorporate sarcopenia assessment using CT-based skeletal muscle mass.
  • To enhance preoperative planning and identify patients needing early intervention.

Main Methods:

  • Analysis of 265 HPV-negative HNSCC patients.
  • Sarcopenia assessment via cervical paraspinal skeletal muscle mass (C3) on CT scans.
  • Development and comparison of Recursive Partitioning analysis (RPA) and Logistic Regression (LR) models against the PEG Score, with validation on a 50-patient cohort.

Main Results:

  • Key predictors identified: male sex, sarcopenia, prior radiotherapy, and adjuvant therapy.
  • The LR model showed the highest AUC (0.78), followed by the RPA model (0.76), both superior to the PEG Score (0.67).
  • The RPA model demonstrated superior validation performance with an AUC of 0.79.

Conclusions:

  • The developed RPA model offers a more precise tool for preoperative risk assessment in HNSCC patients.
  • This model can aid in early intervention strategies for patients at risk of prolonged gastrostomy tube dependence.
  • Improved preoperative planning can potentially enhance patient quality of life and treatment adherence.