Preoperative circulating tumor cells integrated with imaging analysis for prognostic evaluation in head and neck...

Head and neck squamous cell carcinoma (HNSCC) is associated with high locoregional recurrence and poor survival despite multimodal treatment. Reliable biomarkers to guide personalized therapy remain lacking. Circulating tumor cells (CTCs) represent a promising tool, but their clinical utility in HNSCC is insufficiently defined. In this cohort study, 30 stage I-IVb HNSCC patients undergoing curative-intent surgery were enrolled. Preoperative blood samples were analyzed using the FDA-approved CellSearch™ system for CTC count and Programmed death-ligand 1 (PD-L1) expression. Prognostic associations were assessed using Kaplan-Meier analysis and Cox regression. Combined risk models integrating CTC status with radiological features were explored. CTCs were detected in 37.9% (11/29) of patients. CTC positivity was significantly associated with reduced overall survival (P = 0.031). Univariate and bootstrap-adjusted Cox regression identified CTC presence and tumor volume as factors associated with overall survival. Integrating CTC status with tumor volume or nodal stage improved patient stratification, identifying a high-risk group with shorter recurrence-free and overall survival. Preoperative CTC detection may serve as a prognostic biomarker in HNSCC and enhances risk stratification when combined with imaging-derived tumor characteristics, supporting liquid biopsy integration into pre-surgical evaluation.