O009

Friday, November 14th, 2025 17:01 – 17:09
Speaker Simone Eerenstein

Salvage surgery for (chemo)radiation failures in oropharyngeal cancer; does PATH-classification provide a better prognosticator?

Objectives: Salvage surgery for residual or recurrent oropharyngeal squamous cell carcinoma (OPSCC) remains technically demanding and is often associated with poor prognosis. Currently, outcome prediction relies primarily on the rpTNM staging system. In this study, we analyzed our institutional outcomes to evaluate survival after salvage surgery and applied the recently proposed PATH-classification to assess whether it provides superior prognostic value compared to rpTNM staging.

Methods: We performed a retrospective single-institution analysis of salvage surgery outcomes for oropharyngeal squamous cell carcinoma (OPSCC) treated between 2000 and 2023. Overall survival (OS) and disease-specific survival (DSS) were assessed, with subgroup analyses stratified by HPV status. Survival outcomes were estimated using Kaplan–Meier methodology, and univariate analyses were performed with Cox proportional hazards regression. Postoperative morbidity, including complications, persistent tracheostomy, and long-term feeding tube dependence, was recorded.

The PATH-classification, as recently proposed by Léon et al., was adapted to the oropharyngeal salvage setting. The PATH-classification applies recursive partitioning analysis with regression tree methodology, incorporating resection margin status and extranodal extension (ENE). Specifically, in cases of negative or close margins, ENE was considered; in cases of positive margins, nodal involvement was factored. The classification was evaluated for its prognostic value in predicting DSS.

Results: Sixty-one patients underwent salvage for recurrent or residual OPSCC. Post-operative complications occurred in 50.8%, and persistent PEG-tube and tracheotomy dependency in respectively 43.3% and 12%. No significant association was seen with HPV-status. Disease specific survival as based on rpTNM staging was stage I (n=20) 45%, stage II (n=6) 50%, stage III (n=8) 50% and stage IV (n=24) 30.7% (p=0.69). When data were analyzed using the PATH-classification regression tree, the 5-years disease specific survival was: PATH I 41.7% (n=24), PATH II 60% (n=10), PATH III 22.7% (n=22) and PATH IV 40% (n=5) with p<0.001. If pooled, PATH I+II (n=34) 55.7% and PATH III+IV (n=27) 42.3% (p=0.002).

Conclusions: Despite its technical complexity, salvage surgery for recurrent or residual OPSCC is feasible and provides the best chance of long-term survival, with nearly 40% of patients in our cohort achieving 5-year survival. Patient counseling and shared decision-making remain challenging due to the balance of risks and potential benefits. The strong prognostic performance of the PATH-classification in predicting disease-specific survival supports its use as a valuable tool to guide patient counseling and improve individualized treatment planning.