Divergent Roles of Induction Chemotherapy in Patients with Unresectable Locally Advanced Head and Neck Squamous Cell Carcinoma: A Population-Based Matched Cohort Study

Abstract

Background: Induction chemotherapy (IC) has a proven role in organ preservation and reducing distant failure. However, its ability to prolong survival remains controversy.\xa0Herein, we conducted a nationwide population‐based matched cohort study to investigate the association of primary tumor location with the role of IC in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC)\xa0 \n \nMethods: In this population based study, we retrospectively identified patients who aged 18 years and older with newly diagnosed LA-HNSCC between 2007 and 2016 from Taiwan National Health Insurance Research Database and\xa0Taiwan Cancer Registry. Patients were categorized into two group : IC group and definitive CCRT group. The primary tumor locations were classified into four part : oral cavity, oropharynx, hypopharynx and larynx. In order to reduce the selection bias, IC patients were individually matched at a ratio of 1 : 1 with the CCRT patients. The oncologic outcomes were presented with overall survival (OS).\xa0 \n \nFindings: A total of 5547 patients were identified. After 1:1 matching, 1564 patients were analyzed for outcomes comparison, including 782 patients in each group. In general, median OS were 27.3 months versus 28.5 months in IC and CCRT group, respectively (p=0.6151). Patients were thereafter stratified by primary tumor location. For patients with oral cavity and laryngeal cancers, the median OS was significantly inferior in IC group than those in CCRT group, while for patients with oropharyngeal and hypopharyngeal cancer, the median OS was superior in IC group than those in CCRT group.\xa0 \n \nInterpretation: IC has a divergent role in patients with different primary tumor location. Primary tumor location should be taken into consideration when facing the dilemma of IC followed by CCRT or definitive CCRT. Further prospective trials are warranted to confirm our results. \n \nFunding: This work was supported by the Room for Database Research of E-DA HEALTHCARE GROUP (grant no. EDCD2001) \n \nDeclaration of Interest: The authors have nothing to declare \n \nEthical Approval: This study was approved by the Institutional Review Board of the E-Da Cancer Hospital in Taiwan (EMRP-108-061), and the requirements for informed consent were waived.