Neoadjuvant Immunochemotherapy Permits Reduced-Volume Surgery in 90% of Locally Advanced HPV-Negative HNSCC Cases

Yang and colleagues enrolled 52 patients and administered three cycles of PD-1 inhibitor plus chemotherapy, assessing radiographic response before surgery. Patients with ≥50% shrinkage underwent conservative resection that spared uninvolved structures; those with lesser response received standard radical surgery. Forty-two responders reached 90% two-year DFS while the five non-responders reached only 20%, highlighting the prognostic value of early volumetric response. PD-L1 combined positive score correlated with regression depth, suggesting a potential selection biomarker. The single-arm design and modest sample size limit causal inference; selection bias and lack of randomization preclude direct comparison with chemoradiation or upfront surgery benchmarks.