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The objective of this study is to make a synthesis of the prognostic factors in patients with locally advanced head and neck cancer treated with surgery and postoperative chemoradiation with weekly Cisplatin 40mg/m2.

From 2004 to 2020, 133 consecutive patients diagnosed with locally advanced head and neck carcinoma were treated with surgery and postoperative chemoradiotherapy. Cox-regression analysis was used to identify prognostic factors related to recurrence (local, nodal or distant), overall survival (OS) and cancer-specific survival (CSS). 

Mean age at diagnosis was 59 years (range 36-80). 106 (79.1%) were male and 27 (20.9%) were female. 3% of patients were stage II, 9.7% stage III and 87.3% stage IV. All patients received adjuvant radiotherapy up to 66 Gy to the surgical bed concurrently with weekly cisplatin 40mg/m2. Median follow-up was 60 months (4-187).  Cancer-specific survival (CSS) was lower in patients with extranodal extension (ENE) (p=0.003), higher pN stage (p=0.017) and if ≥ 2 involved lymph nodes (p=0.02).  OS was also lower in patients with ≥ 2 involved nodes (p=0.007), higher pN stage (p=0.004) and if radiotherapy treatment was ≥ 8 weeks (p=0.013). Local relapse was at increased risk in patients with higher pT stage (p=0.001), positive surgical margins (p=0.023) or if less than 5 cycles of weekly-cisplatin were administered (p=0.037). Lymph node relpase-free survival was lower in patients with positive ENE (p = 0.042).  Risk of metastasis was higher in patients with extranodal lymph node involvement (p=0.025) and higher pN stage (p=0.003).

Taking into account clinical and pathological prognostic factors, head and neck cancer patients with higher pN stage and/or ECE are at higher risk of relapse and death so treatment intensification strategies should be explore in this subgroup of patients.