This single-center retrospective cohort study compared pathologic response rates between neoadjuvant immunotherapy alone (NAI) and neoadjuvant chemoimmunotherapy (NACI) in 86 adults with resectable HNSCC of the aerodigestive tract, treated at a tertiary academic center from July 2024 to March 2026.
Deep pathologic response (pCR or MPR) occurred in 39/58 NACI recipients (67%) vs. 1/28 NAI recipients (3.6%); propensity score-adjusted OR for pCR or MPR with NACI was 29.1 (95% CI, 6.7–274.7). Overall, 25 patients (29%) achieved pCR and 15 (17%) achieved MPR. Treatment was generally well tolerated with few adverse event-related surgical delays.
- Single-center retrospective design with a small sample (n=86) limits generalizability and statistical precision. - Wide confidence intervals (especially in the adjusted OR: 6.7–274.7) reflect limited statistical power and residual confounding despite propensity score adjustment. - No survival outcomes reported; pathologic response is a surrogate endpoint whose link to OS in this context remains unconfirmed.
NACI produced dramatically higher deep pathologic response rates than NAI alone in resectable HNSCC (67% vs. 3.6%), without apparent excess surgical delays. Clinicians should consider combination chemoimmunotherapy in the neoadjuvant setting, while awaiting prospective trial data on survival benefit.
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