BACKGROUND:The prognostic implications of regional lymph node metastases at the initiation of immune checkpoint inhibitor (ICI) therapy in oral cavity squamous cell carcinoma (OCSCC) are not well defined. This study evaluated whether the presence of metastatic cervical lymph nodes at the start of pembrolizumab therapy was associated with progression-free or overall survival among patients with recurrent or metastatic (R/M) OCSCC. METHODS:A retrospective cohort study was conducted at a tertiary academic medical center including patients with R/M OCSCC who initiated pembrolizumab between May 2016 and May 2022. Patients receiving fewer than three cycles were excluded. The presence of metastatic lymph node(s) at ICI initiation was analyzed as a dichotomous variable. The primary outcome was 6-month progression-free survival (PFS), and the secondary outcome was 2-year overall survival (OS). Disease progression was determined using RECIST-based radiographic criteria. Cox proportional hazards models adjusted for age, PD-L1 status, presence of distant metastases, and receipt of concurrent systemic therapy. RESULTS:Forty-five patients met inclusion criteria; all received pembrolizumab for R/M disease. Twelve patients (27%) had metastatic cervical lymph nodes at ICI initiation. On univariate analysis, nodal metastasis was associated with poorer 6-month PFS (p = 0.024). After adjustment for age, PD-L1 status, distant metastases, and concurrent systemic therapy, cervical nodal metastasis remained independently associated with inferior PFS (HR 5.12; 95% CI 1.30-20.2; p = 0.020). CONCLUSIONS:Presence of metastatic cervical lymph nodes at the start of pembrolizumab therapy was associated with reduced 6-month progression-free survival, suggesting regional disease burden may predict limited ICI benefit in R/M OCSCC.

Reliable prognostic models for recurrence after surgery and adjuvant radiation therapy in oral cavity cancer (OCC) remain limited. We developed a tumoroid-based multi-parameter index (MPI) integrating ex vivo radiation-response AUC, tumoroid growth rate, and TNM stage to predict two-year recurrence. Patient-derived tumoroids were established from Korean patients with OCC (n = 16), and the MPI was constructed using multivariable logistic regression. At the prespecified cut-off of 0.5, the MPI achieved 90.00

Objective: Timely, accurate referrals to head and neck cancer surgery are essential for survival but are often delayed or misrouted, contributing to late-stage presentation and disparities. We aim to develop and validate a supervised neural network to predict surgical appropriateness at the time of referral. Methods: Training data included >200 000 de-identified patient records from the National Cancer Database and Surveillance, Epidemiology, and End Results registries. External validation was conducted on 39 consecutive referrals at a tertiary care center (2020-2023) using demographics, tumor site, histology, TNM stage, and grade. Model outputs were compared to treatment recommendations from head and neck surgeons. Results: The model achieved 79% accuracy, 85% sensitivity, 50% specificity, and 90% positive predictive value in identifying surgical candidates. Performance was consistent across sex, age, and socioeconomic subgroups, with a trend toward improved accuracy in lower-stage disease. Conclusions: This externally validated tool demonstrates potential to streamline referral triage, expedite surgical consultation, and enhance equitable access to head and neck cancer care.

OBJECTIVE:To determine the relationship between perineural invasion and 6-month progression-free survival (PFS)/2-year overall survival (OS) among patients with recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) on pembrolizumab. METHODS:This study was a retrospective, observational study performed at a tertiary care academic center. Participants included patients with oral cavity, oropharynx, hypopharynx, and laryngeal head and neck squamous cell carcinoma who began pembrolizumab treatment at UCSF between May 2016 and May 2022. The primary outcome was 6-month progression-free survival and 6-month time-to-progression (TTP). The secondary outcome was 2-year overall survival. Disease progression was determined using radiographic criteria, adopted from the Response Evaluation Criteria in Solid Tumors. RESULTS:One hundred and thirty-three patients with HNSCC were included. Immune checkpoint inhibitor (ICI) indication was recurrence/metastasis for all patients. Forty (30%) patients had perineural invasion. On univariate analysis, patients with perineural invasion were more likely to have worse 6-month PFS (p = 0.011). After controlling for number of metastatic organs, receipt of concurrent systemic therapy, age, and PDL-1 status, presence of perineural invasion was associated with worse 6-month PFS [HR 3.33 (1.32, 8.41), p = 0.011] and 6-month time to progression (TTP) [HR 2.14 (1.09, 7.38), p = 0.032], but was not significantly associated with 2-year OS [HR 1.35 (0.57, 3.19), p = 0.498]. CONCLUSION:Presence of perineural invasion is associated with poorer 6-month progression-free survival on ICI in patients with HNSCC. Future studies should further explore how perineural invasion may alter response to immunotherapy. LEVEL OF EVIDENCE: 3:

BACKGROUND:A minority of patients receiving immunotherapy for oropharyngeal head and neck squamous cell carcinoma benefit. Finding biomarkers that predict response to ICI is important for improving outcomes in these patients. In this study, we determine the relationship between pretreatment neutrophil-to-lymphocyte ratio (NLR) and 6-month progression-free survival (PFS)/2-year overall survival (OS) among patients with recurrent or metastatic (R/M) oropharyngeal cancer on pembrolizumab. METHODS:This study was a retrospective cohort study of patients with recurrent/metastatic OPSCC who were treated with pembrolizumab between May 2016 and May 2022 at a tertiary care academic center. The primary outcome was 6-month progression-free survival. The secondary outcome was 2-year overall survival. NLR was treated as a continuous and dichotomous variable. Disease progression was determined using radiographic criteria adopted from the Response Evaluation Criteria in Solid Tumors. RESULTS:Sixty-four patients with OPSCC were included. The median pre-treatment NLR was 5.1 (IQR 3.1-8.3). Thirty-seven (58%) patients had distant metastases at the start of ICI. When treated as a continuous variable, higher pretreatment NLR was associated with poorer 6-month PFS [HR 1.14 (1.03, 1.27), p = 0.016] and 2-year OS [HR 1.21 (1.09, 1.35), p = 0.001] for patients on pembrolizumab. Subgroup analyzes on patients who were p16+ versus p16- revealed that NLR was only associated with poorer survival for p16+ patients [HR 1.16 (1.00, 1.33), p = 0.046 versus HR 1.11 (0.94, 1.31), p = 0.203, respectively]. CONCLUSION:Higher pretreatment NLR was associated with poorer 6-month PFS and 2-year OS in OPSCC patients treated with pembrolizumab. When stratified by p16 status, this association only remained significant among p16+ patients.

Adenoid cystic carcinoma (ACC) is a rare salivary gland malignancy with no FDA-approved systemic therapies and limited benefit from conventional treatments. Proteogenomic profiling has revealed consistent overexpression of AXL, providing a compelling rationale to pursue AXL as a novel therapeutic target. We investigated mipasetamab uzoptirine (ADCT-601), an AXL-targeting antibody-drug conjugate (ADC) with pyrrolobenzodiazepine dimer payload, in preclinical models of ACC. In vitro cytotoxicity was assessed in AXL-positive cell lines, and in vivo efficacy was evaluated using cell line xenograft and patient-derived xenograft (PDX) models. ADCT-601 demonstrated potent and selective cytotoxicity in AXL-expressing ACC cell lines. In xenograft models, a single administration at 0.5 or 1.0 mg/kg induced significant tumor regression, with complete tumor eradication observed at 1.0 mg/kg. Across a panel of ACC PDX models, ADCT-601 produced strong yet variable anti-tumor activity, with therapeutic response correlating with AXL expression levels. ADCT-601 demonstrates robust AXL expression linked to anti-tumor activity in preclinical models of ACC, establishing a proof of concept for targeting AXL in this rare cancer. These findings support clinical translation of AXL-targeting ADC as a novel biomarker-driven therapy for patients with ACC.

BACKGROUND:Timely referral to subspecialty care remains critical for expedited work up and treatment of HPV+ oropharyngeal carcinoma (OPSCC). It is not known if there have been changes in time to diagnosis as the incidence of this disease rises. METHODS:Retrospective cohort study of 312 patients treated for HPV+ OPSCC at a tertiary referral clinic between 2013 and 2022. RESULTS:There was a significant difference in time to diagnosis based on year of presentation (p < 0.001). More patients presented with early-stage disease (AJCC 7 Stage I or II) over time (p = 0.002). Presenting symptom (p = 0.021) and patient location ≥ 50 miles from our tertiary referral clinic (p = 0.039) also affected time to diagnosis. CONCLUSIONS:Time to diagnosis of HPV+ OPSCC changed based on year of presentation, and a higher proportion of patients presented with early-stage disease in more recent years. This may reflect an increased public awareness of HPV+ OPSCC and its symptoms.

ABSTRACT Objective Limited literature focuses on delays in accessing head and neck cancer (HNC) care across the entire care continuum. This study aims to describe the time to care from symptom onset to treatment completion and identify predictors of delays for oral cavity cancer patients. Methods We reviewed patients with oral cavity squamous cell carcinoma (OCSCC) treated with curative surgery followed by adjuvant treatment at a tertiary center. Delays were defined per published thresholds for: time to treatment initiation (TTI, diagnosis to surgery), time to adjuvant treatment (stratified by whether adjuvant treatment was at the same or different facility as surgery), and total treatment package time. We also measured symptom duration, reported median times, and used logistic regression to assess predictors of delay. Results Among 93 patients, median (IQR) symptom duration was 17.4 weeks (IQR: 6.8–42.8); TTI 6.9 weeks (IQR: 4.4–10.4); time to adjuvant radiation 8.4 weeks (IQR: 7.4–9.3) at the same institution as surgery was performed and 9.3 weeks (IQR: 7.4–14) at a different facility; and total treatment package time 15.4 weeks (IQR: 12.6–20) for surgery and adjuvant radiation, and 16.3 weeks (IQR: 15–18.6) for surgery and adjuvant chemoradiation. 73% of patients experienced delays in reaching a healthcare facility, 39% in TTI, 89% in starting adjuvant treatment, and 64%–81% in total treatment time. In univariate analyses, late‐stage disease, residing in a community with higher social vulnerability index (SVI), longer time from surgery to pathology report, need for free flap, and social worker interaction were associated with higher odds of delay in any care interval following diagnosis. Higher SVI was associated with delays in multivariate analyses. Conclusion HNC patients experience delays during all phases of cancer care. Interventions and future research need to address social determinants of health and health system factors that contribute to multifactorial delays across the care continuum.

BACKGROUND:Salivary gland adenoid cystic carcinoma (ACC) is a rare and challenging form of head and neck cancer, particularly difficult to treat once it progresses to recurrent or metastatic disease. In this study, we evaluate the cytotoxicity and anti-tumorigenic effects of CWP232291, a first-in-class small molecule inhibitor targeting the Wnt-β-catenin signaling pathway. METHODS:Tumor microarrays of ACC patients and patient-derived xenografts (PDX) were evaluated by immunohistochemistry, RNA-seq, and qRT-PCR analysis for β-catenin. The effects of CWP232291 were determined by cytotoxic, qRT-PCR, and immunoblotting analysis. In vivo anti-tumorigenic effects of CWP232291 were evaluated using cell line xenograft and PDX models. RESULTS:Immunohistochemistry analysis revealed that high β-catenin expression correlated with reduced overall survival in ACC patients. Expression of genes involved in the Wnt-β-catenin pathway was enriched in PDX samples. In vitro cytotoxicity and biochemical assays using MDA-ACC-01 and UM-HACC-2A cell lines revealed that ACC cells were susceptible to CWP232291. Furthermore, CWP232291 treatment attenuated in vivo tumor growth in both cell line xenograft and PDX models. CONCLUSIONS:Abnormal Wnt-β-catenin signaling may play an active role in ACC pathogenesis, and its inhibition by CWP232291 may offer therapeutic potential, representing a promising avenue for further investigation.

OBJECTIVE:In head and neck cancer (HNC) survivors not actively receiving dysphagia care, long-term dysphagia prevalence, dysphagia-related complications, and quality of life outcomes remain poorly understood. Understanding these outcomes is critical for creating effective HNC survivorship programs. METHODS:HNC survivors who completed cancer treatment > 2 years prior who had not undergone a swallow evaluation or therapy for > 1 year completed the MD Anderson Dysphagia Inventory (MDADI) and reported dysphagia-related complications. RESULTS:Of 722 invited participants who met inclusion criteria, 143 responded at a median of 5.9 years (IQR: 2.5-10.2 years) post-treatment, including 65 at 2-5 years, 42 at 5-10 years, and 36 at > 10 years. Median time since last speech-language pathologist visit was 2.8 years (IQR 2.1-4.9 years), and 27% had not received any swallow therapy since cancer treatment completion. The most common tumor subsite was oropharynx (n = 103), and most underwent definitive (n = 72) or adjuvant (n = 60) (chemo)radiation. The overall median MDADI score was 80 points (IQR: 62.1-91.6) and 49.6% (n = 71) had moderate to severe dysphagia (MDADI < 80). The most common complications within the 6 months prior to patient contact were unintentional weight loss (7.7%), current gastrostomy tube dependence (4.9%), aspiration pneumonia (1.4%), and dehydration requiring intravenous fluids (1.4%). An MDADI score ≤ 80 was associated with 7.7 times higher odds of dysphagia-related adverse events (95% CI 2.1-28.2, p = 0.002). CONCLUSIONS:Long-term dysphagia is prevalent among HNC survivors not actively receiving dysphagia care, highlighting the need for ongoing swallow function surveillance and proactive dysphagia management strategies tailored to this population. LEVEL OF EVIDENCE: 3:

Supplementary Figure from Relations of Current and Past Cancer with Severe Outcomes among 104,590 Hospitalized COVID-19 Patients: The COVID EHR Cohort at the University of Wisconsin

BACKGROUND:This study aimed to evaluate swallow outcomes in head and neck cancer (HNC) survivors enrolled in a long-term dysphagia surveillance protocol following curative intent radiotherapy (RT). METHODS:We conducted a retrospective review of videofluoroscopic swallow studies from 2015 to 2023 in HNC patients treated with RT. Swallow kinematics and function were assessed at baseline, 0-1, 1-2, 2-5, and 5+ years post-RT. Logistic regression models assessed kinematic deviations beyond 2SD from normative and dichotomized outcomes. RESULTS:Among 638 patients with 1167 VFSS, 14.6% were 2 years post-RT, primarily oral cavity (29.6%) and oropharyngeal (46.7%) cancers treated with adjuvant (chemo) RT (53.3%). At 2 years, 51.3% exhibited abnormal hyolaryngeal movement, 27.5% had pharyngeal contraction abnormalities, and 9.0% had impaired pharyngoesophageal opening. Unsafe swallow was seen in 51.6% with moderate-to-profound dysphagia in 45%. CONCLUSION:Dysphagia surveillance revealed significant swallowing impairments in HNC survivors, with unsafe swallowing prevalent in over half of cases 2 years post-RT.

IMPORTANCE Understanding the clinical course and malignant transformation rate of oral potentially malignant disorders (OPMDs)-including oral leukoplakia, oral erythroplakia, oral submucous fibrosis, and oral lichen planus-is crucial for early detection and improved survival rates in patients with oral cancer. OBJECTIVE To evaluate the progression of oral cancer from OPMDs using a large US electronic medical database. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the University of California, San Francisco's PatientExploreR database between January 1973 and March 2024. Patients with oral leukoplakia, oral erythroplakia, oral submucous fibrosis, and oral lichen planus were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes and keywords. Demographics, tobacco and alcohol use, HIV status, and other known risk factors for oral cancer were recorded to identify factors associated with malignant transformation. Logistic regression and descriptive analyses were used. EXPOSURE Diagnosis of oral leukoplakia, oral erythroplakia, oral submucous fibrosis, or oral lichen planus. MAIN OUTCOMES AND MEASURES Incidence of oral cancer, malignant transformation rate, median time to progression, and associations between demographics and risk factors and the development of oral cancer. RESULTS Among 4225 251 individuals in the database, 4371 were diagnosed with oral cancer (median [IQR] age, 63 [53-71] years; 2610 [59.9%] male; 0.1% of the cohort), and 110 (2.5%) had a preceding OPMD. Oral leukoplakia was found in 1124 patients, with 94 (8.4%) undergoing malignant transformation (median [IQR] time to progression, 25 [7-129] months). HIV-positive patients with oral leukoplakia were more likely to develop oral cancer (odds ratio, 3.80; 95% CI, 1.35-10.70). Of 22 patients with oral erythroplakia, 11(50.0%) developed oral cancer (median [IQR] time to progression, 3.7 [0.2-334] months). Those who smoked tobacco with oral erythroplakia showed a higher malignant transformation rate (odds ratio, 3.75; 95% CI, 0.54-26.05). Of the 78 patients with oral submucous fibrosis, 4(5.1%) underwent malignant transformation (median [IQR] time to progression, 36 [36-48] months). Only 1 patient with oral lichen planus developed oral cancer after 5 years. CONCLUSIONS AND RELEVANCE This cohort study showed that OPMDs have notable but varying propensities to progress to oral cancer. Early detection and monitoring of OPMDs are crucial for improving patient outcomes. However, the risk, etiopathogenesis, and clinical presentation vary for each OPMD and should, therefore, be considered distinct diseases.

ObjectiveTo determine the relationship between pretreatment neutrophil-to-lymphocyte ratio (NLR) and 6-month progression-free survival (PFS)/2-year overall survival (OS) among patients with recurrent or metastatic (R/M) oral cavity cancer on pembrolizumab. Study DesignThis study was a retrospective, observational study performed at a tertiary care academic center. SettingParticipants included patients with oral cavity squamous cell carcinoma (OCSCC) who began pembrolizumab treatment at the University of California, San Francisco between May 2016 and May 2022. MethodsThe primary outcome was a 6-month PFS. The secondary outcome was a 2-year OS. NLR was treated as a continuous variable. Disease progression was determined using radiographic criteria, adopted from the Response Evaluation Criteria in Solid Tumors. ResultsFifty-two patients with OCSCC were included. Immune checkpoint inhibitor (ICI) indication was recurrence/metastasis for all patients. The median pretreatment NLR was 5.7 (interquartile range: 3.6-7.6). Twenty-seven (55%) patients received pembrolizumab alone. Of those receiving treatment for R/M prior to ICI, 9 (18%) received salvage surgery and adjuvant therapy, 2 (4%) received chemotherapy alone, 1 (2%) received chemoradiation, and 10 (20%) received salvage surgery. Nineteen (36.5%) patients had distant metastases at the start of ICI. Six-month PFS was 46%. Two-year OS was 44%. NLR was independently associated with 6-month PFS [hazard ratio, HR: 1.05 (95% confidence interval, CI: 1.01-1.11), P = .028] and 2-year OS [HR: 1.12 (95% CI: 1.05-1.20), P < .001]. ConclusionHigher pretreatment NLR was associated with poorer 6-month PFS and 2-year OS in OCSCC patients treated with pembrolizumab.

Fibroblast activation protein (FAP), expressed in the tumor microenvironment of a variety of cancers, has become a target of novel PET tracers. The purpose of this report is to evaluate the imaging characteristics of 68Ga-FAP-2286, present the first-to our knowledge-dosimetry analysis to date, and compare the agent with 18F-FDG and FAPI compounds. Methods: Patients were administered 219 ± 43 MBq of 68Ga-FAP-2286 and scanned after 60 min. Uptake was measured in up to 5 lesions per patient and within the kidneys, spleen, liver, and mediastinum (blood pool). Absorbed doses were evaluated using MIM Encore and OLINDA/EXM version 1.1 using the International Commission on Radiological Protection publication 103 tissue weighting factor. Results: Forty-six patients were imaged with 68Ga-FAP-2286 PET. The highest average uptake was seen in sarcoma, cholangiocarcinoma, and colon cancer. The lowest uptake was found in lung cancer and testicular cancer. The average SUVmax was significantly higher on 68Ga-FAP-2286 PET than on 18F-FDG PET in cholangiocarcinoma (18.2 ± 6.4 vs. 9.1 ± 5.0, P = 0.007), breast cancer (11.1 ± 6.8 vs. 4.1 ± 2.2, P < 0.001), colon cancer (13.8 ± 2.2 vs. 7.6 ± 1.7, P = 0.001), hepatocellular carcinoma (9.3 ± 3.5 vs. 4.7 ± 1.3, P = 0.01), head and neck cancer (11.3 ± 3.5 vs. 7.6 ± 5.5, P = 0.04), and pancreatic adenocarcinoma (7.4 ± 1.8 vs. 3.7 ± 1.0, P = 0.01). The total-body effective dose was estimated at 1.16E-02 mSv/MBq, with the greatest absorbed organ dose in the urinary bladder wall (9.98E-02 mGy/MBq). Conclusion: 68Ga-FAP-2286 biodistribution, dosimetry, and tumor uptake were similar to those of previously reported FAPI compounds. Additionally,68Ga-FAP-2286 PET had consistently higher uptake than 18F-FDG PET. These results are especially promising in the setting of small-volume disease and differentiating tumor from inflammatory uptake.

BACKGROUND:Complications following head and neck microvascular free tissue transfer (MFTT) are common. Less is known about when they occur. METHOD:Retrospective study of patients with primary or recurrent head and neck cancer undergoing MFTT reconstruction at a tertiary care institution. MFTT reconstructions with inpatient postoperative complications were included. The Kruskal-Wallis test was used to compare median postoperative day (POD) onset of complication by flap type. RESULTS:Of 1090 patients undergoing MFTT reconstruction, 126 (11.6%) patients experienced inpatient complications including fibula (n = 35), anterolateral thigh (n = 60), or radial forearm (n = 31) MFTTs. POD onset was shortest for surgical site hematoma (median = 1 [IQR 1-5]), and longest for donor site infection (median = 11.5 [IQR 8-15]). There was no significant difference between flap types and POD onset of complications (p > 0.05). CONCLUSION:Hematoma formation and flap failure occur earliest during hospitalization, while dehiscence, infection, and fistula occur later. There is no difference in complication timing between flap types.

Abstract Adenoid cystic carcinoma (ACC) is a rare type of salivary gland cancer. Despite the many advances made in helping understand the disease behavior and characteristics, the prevailing challenge in managing patients with ACC is the lack of clinically approved systemic therapy drugs to successfully treat those with advanced recurrent or metastatic disease. There are multiple promising candidate agents being evaluated preclinically and in early phase clinical trials, yet an effective drug with consistent overall response remains to be identified. AXL is a member of the TAM family of tyrosine kinase receptors, and its overexpression and activation is generally associated with poor prognosis and chemoresistance in many cancer types. Previous reports show AXL is significantly upregulated in a subset of ACC tumors. Here, we evaluate the tumor growth inhibition effects of a newly developed antibody-drug-conjugate targeting AXL (ADCT-601) in a xenograft ACC cell line model. MDA-ACC-01 cells express high levels of cell surface AXL as confirmed by biochemical analysis. The tumor growth inhibition of MDA-ACC-01 cell xenograft was tested in a single-dose drug administration study. Immunodeficient mice bearing ACC tumors were either injected with vehicle (n=7) or with ADCT-601 at 0.5 (n=9) or 1.0 mg/kg (n=7). ADCT-601 treatment with either 0.5 mg/kg or 1.0 mg/kg resulted in complete response (CR) for all tumor implants. To reaffirm the drug’s efficacy, we challenged the vehicle-treated tumor, prior to exceeding the tumor volume endpoint, with a single-dose of ADCT-601 at 1.0 mg/kg. Strikingly, by day 6 post-treatment, tumor volume began to shrink and eventually resulted in CR except in all but one case. These results demonstrate ADCT-601 is an effective drug with significant anti-tumor activity in our preclinical models and is worthy of additional investigation to determine its translational potential. Citation Format: Joseph O. Humtsoe, Anita Pothukuchi, Hyunseok Kang, Patrick Ha. Preclinical anti-tumorigenic evaluation of AXL targeting antibody-drug-conjugate in an adenoid cystic carcinoma cell line xenograft model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB022.

OBJECTIVES:To describe the clinicopathologic presentation of buccal squamous cell carcinoma and identify risks factors for recurrence and overall survival. METHODS:This is a retrospective case-control study of patients with oral cavity squamous cell carcinoma (OCSCC) treated at a single tertiary care center between 2010 and 2022. All patients with buccal subsite OCSCC treated during this time frame were included and paired with a randomly selected age and gender matched patient with non-buccal OCSCC. Relevant data was collected via chart review. RESULTS:Seventy-seven patients with buccal SCC were matched with 77 non-buccal OCSCC controls. The median follow-up time was 27 months (IQR 14-61). Median age was 67 years (IQR 57-75) and 53% of the cohort was female. Twenty (26%) buccal SCC patients experienced a recurrence versus 19 (25%) in the controls. Age ≥65-years-old increased odds of all-cause mortality in the buccal SCC group, but not in the control group. Perineural invasion and positive margins increased odds of recurrence in the buccal group only. Overall survival and progression-free survival did not differ between the groups, despite a greater number of T2 buccal tumors and T1 non-buccal tumors. CONCLUSIONS:Buccal SCC presents at a higher T stage than other oral cavity SCC subsite and may exhibit variance in the pathologic risk factors that predict poor outcomes versus non-buccal OCSCC. Despite these relatively minor differences, however, oncologic outcomes between these groups were similar.

Abstract Objective Few studies characterizing clinical outcomes of head and neck cancer (HNC) patients in sub-Saharan Africa report the proportion of patients who initiate and complete treatment, information integral to contextualizing survival outcomes. This retrospective cohort study describes HNC patients who presented to Muhimbili National Hospital and Ocean Road Cancer Institute in 2018, the highest-volume oncology tertiary referral centers in Tanzania. Logistic regression was applied to assess predictors of treatment initiation and completion. Results Among the 176 head and neck squamous cell carcinoma (HNSCC) patients, 34% (59) had no treatment documented, 34%(59) had documentation of treatment initiation but not completion, and 33%(58) had documentation of treatment completion based on the modalities started. Univariate logistic regression showed that late-stage disease was associated with increased odds of initiating treatment (OR 8.24, 95% CI 2.05–33.11, p = 0.003) and trends toward completing treatment (OR 7.41, 95% CI 0.90–60.99, p = 0.063). At last visit, 36.9%(65) were alive with a median follow up of 5.6 months (IQR 1.64—12.5 months). A large proportion of HNC patients who presented to MNH and ORCI did not initiate or complete treatment. These metrics are critical to contextualize care outcomes of HNC patients in resource-constrained health systems and develop interventions.