ArticleBMC oral health2026
Initial pN and differentiation at recurrence as prognostic factors in patients with recurrent or metastatic tongue squamous cell carcinoma undergoing re-resection.
Article in BMC oral health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis study primarily aimed to identify prognostic factors for patients with recurrent/metastatic tongue squamous cell carcinoma (R/M TSCC) undergoing re-resection and to preliminarily explore the value of baseline metabolic parameters in predicting pathological response after neoadjuvant therapy (NAT). MATERIALS AND
methodsIn the primary analyses, we analyzed 114 patients with R/M TSCC who underwent direct re-resection or re-resection after NAT between 2017 and 2024. Clinical, pathological, and PET/CT parameters were collected. Lasso-Cox regression was performed to identify factors influencing disease-free survival (DFS) and overall survival (OS), with internal validation via bootstrapping with 1000 resamples. Sensitivity analysis was performed to test the robustness of the main findings by restricting the analysis to the 100 patients who underwent elective neck dissection (a subgroup of the 114 patients). Patients undergoing re-resection after NAT were grouped by pathological response (pCR/MPR vs. non-MPR) for comparison.
resultsMedian follow-up was 43.0 months (110 were evaluable), with 53 deaths and 46 remaining recurrence-free. Initial pathological N status and differentiation at recurrence were prognostic factors for both DFS and OS, with HRs of 2.29 (95% CI: 1.40-3.77, P = 0.001), 2.62 (95% CI: 1.48-4.62, P < 0.001), 2.75 (95% CI: 1.57-4.80, P < 0.001), and 2.87 (95% CI: 1.47-5.61, P = 0.002), respectively. The robustness of initial pathological N status for OS, differentiation at recurrence for both DFS and OS were testified by sensitivity analyses. Among the 26 patients who underwent re-resection after NAT, the pCR/MPR group showed higher SULmax (P = 0.033) and SUR (P = 0.041) and had longer DFS (P = 0.045) than the non-MPR group, while no significant difference in OS was observed between the two subgroups.
conclusionsInitial pN positivity is associated with worse OS, and moderate to low differentiation at recurrence might be associated with worse DFS and OS in R/M TSCC patients undergoing re-resection. Baseline metabolic parameters might have the potential to identify pathological response after NAT. CLINICAL RELEVANCE: Identifying risk factors for survival in R/M TSCC patients treated with re-resection is crucial for tailoring postoperative strategies.
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