Observation on the Surgical Efficacy of Neoadjuvant Immunotherapy Combined with Chemotherapy for Locally Advanced...

Neoadjuvant immunotherapy combined with chemotherapy (NICT) improves tumor downstaging in locally advanced hypopharyngeal squamous cell carcinoma (LA-HSCC), but the effect of response-adapted surgery on outcomes is unclear. This study evaluated the efficacy and safety of NICT and compared minimally invasive versus open surgery on the basis of treatment response.

We retrospectively analyzed 79 patients with stage III-IVB HSCC who received NICT. Treatment response was assessed per RECIST 1.1, and surgery was tailored accordingly. The objective response rate was 84.81%, and the pathological complete response rate was 59.49%. Grade ≥ 3 treatment-related adverse events occurred in 11.39% of patients.

Following NICT, 73.4% of patients underwent transoral minimally invasive surgery, 17.7% partial laryngectomy, and 8.8% total laryngectomy, resulting in a laryngeal preservation rate of 91.14%. With a median follow-up of 15 months, there were no significant differences in progression-free or overall survival between surgical groups. However, the minimally invasive group had significantly better 1-year respiratory (89.66% versus 35.71%, p < 0.001) and phonatory (70.69% versus 0%, p < 0.001) function preservation compared to the open surgery group.

Multivariate analysis confirmed that minimally invasive surgery independently predicted improved respiratory function. NICT enables high response and organ preservation in LA-HSCC, and minimally invasive surgery achieves comparable survival with superior functional outcomes, supporting its use in a personalized treatment approach.