World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://wjon.elmerpub.com

Original Article

Volume 16, Number 1, February 2025, pages 59-69

Discordant Responses Between Imaging Examination and Surgical Pathology of Head and Heck Squamous Cell Carcinoma After Neoadjuvant Immunotherapy Combined With Chemotherapy

Figure 3. A case of tongue squamous cell carcinoma with cervical lymph node metastasis treated by surgery after two cycles of NICC. (a) Before NICC, enhanced MRI suggested that an abnormal signal mass is seen on the left side of the tongue, with irregular shape and maximum cross-sectional area of approximately 5.5 × 3.8 cm (arrow). (b) Multiple enlarged lymph nodes are seen on the left side of the neck, with the largest one having a short axis of approximately 1.7 cm (arrow). (c) Before NICC, enhanced CT showed a lesion on the left side of the tongue with an irregular shape and a maximum cross-sectional area of approximately 5.3 × 3.0 cm (arrow). (d) There are multiple lymph nodes in the neck, with the largest having a short diameter of about 1.7 cm (arrow). After NICC, enhanced MRI suggested that abnormal signal shadow is seen on the left side of the tongue, with irregular shape, smaller range and uneven signal. (f) The maximum cross-section was about 4.3 × 2.1 cm (arrow), which was considered to be better after NICC than before. (g) Most of the lymphatic nodes of the left neck were smaller than before, and the short diameter of the larger ones was about 1.4 cm (arrow). (h) After NICC, enhanced CT revealed a left-sided mass in the tongue, smaller than before, with unclear boundaries, and the current range was about 4.5 × 3.2 cm (arrow). (i) Multiple lymph nodes in the left neck were smaller than before, and the short diameter of the larger ones was about 1.3cm (arrow). The postoperative pathology report indicated PrCR (e) and LCR (j), while imagine examination still indicated the presence of tumor (f-i). NICC: neoadjuvant immunotherapy combined with chemotherapy; CT: computed tomography; MRI: magnetic resonance imaging; PrCR: complete response of the primary site; LCR: complete response of the lymph node.

**Table 1.** Characteristics of the Cohort
Clinical characters	Number (%)
ICIs: immune checkpoint inhibitors; NLR: the ratio of neutrophils to lymphocytes; NEU: neutrophil; LYM: lymphocyte.
Gender
Female	2 (4.9)
Male	39 (95.1)
Age (years), mean (min - max)	59.61 (34 - 75)
Tumor types
Oropharyngeal cancer	11 (26.8)
Hypopharyngeal cancer	25 (61.0)
Oral cancer	4 (9.8)
Laryngeal cancer	1 (2.4)
Multiple cancer
No	37 (90.2)
Yes	4 (9.8)
Differentiation
High	5 (12.2)
Mid	23 (56.1)
Poor	13 (31.7)
T state
T1	5 (12.2)
T2	15 (36.6)
T3	8 (19.5)
T4a	13 (31.7)
N sate
N0	3 (7.3)
N1	1 (2.4)
N2a	1 (2.4)
N2b	24 (58.5)
N2c	6 (14.6)
N3a	0 (0)
N3b	6 (14.6)
ICIs types
Pabolizumab	27 (65.9)
Tirellizumab	10 (24.4)
Triplimab	3 (7.3)
Sindilizumab	1 (2.4)
Immunotherapy cycle
1	3 (7.3)
2	31 (75.6)
3	7 (17.1)
Blood routine parameters, mean (min - max)
NEU (× 10⁹/L)	4.83 (2.15 - 12.24)
LYM (× 10⁹/L)	1.68 (0.61 - 2.91)
NLR	1.68 (1.28 - 7.18)
Total	41 (100)

Table 1. Characteristics of the Cohort

Clinical characters

Number (%)

ICIs: immune checkpoint inhibitors; NLR: the ratio of neutrophils to lymphocytes; NEU: neutrophil; LYM: lymphocyte.

Gender

Female

2 (4.9)

Male

39 (95.1)

Age (years), mean (min - max)

59.61 (34 - 75)

Tumor types

Oropharyngeal cancer

11 (26.8)

Hypopharyngeal cancer

25 (61.0)

Oral cancer

4 (9.8)

Laryngeal cancer

1 (2.4)

Multiple cancer

37 (90.2)

Yes

4 (9.8)

Differentiation

High

5 (12.2)

Mid

23 (56.1)

Poor

13 (31.7)

T state

5 (12.2)

15 (36.6)

8 (19.5)

T4a

13 (31.7)

N sate

3 (7.3)

1 (2.4)

N2a

1 (2.4)

N2b

24 (58.5)

N2c

6 (14.6)

N3a

0 (0)

N3b

6 (14.6)

ICIs types

Pabolizumab

27 (65.9)

Tirellizumab

10 (24.4)

Triplimab

3 (7.3)

Sindilizumab

1 (2.4)

Immunotherapy cycle

3 (7.3)

31 (75.6)

7 (17.1)

Blood routine parameters, mean (min - max)

NEU (× 10⁹/L)

4.83 (2.15 - 12.24)

LYM (× 10⁹/L)

1.68 (0.61 - 2.91)

NLR

1.68 (1.28 - 7.18)

Total

41 (100)

**Table 2.** The Characters and the Difference Between Enhanced CT and Pathology
Clinical characters	Pathology (%)	Enhanced CT (%)	P value
PrCR: complete response of the primary site; PLCR: complete response of the primary site and the lymph node; LCR: complete response of the lymph node; TR: tumor response; CT: computed tomography.
TR			0.094
Mild	9 (22.0)	7 (17.1)
Moderate	7 (17.1)	22 (53.7)
Severe	25 (61.0)	12 (29.3)
PrCR			< 0.001
Yes	17 (41.5)	2 (4.9)
No	24 (58.5)	39 (95.1)
LCR			< 0.001
Yes	22 (53.7)	5 (12.2)
No	19 (46.3)	36 (87.8)
PLCR			< 0.001
Yes	13 (31.7)	0 (0)
No	28 (68.3)	41 (100)
The maximum diameter of the primary lesion (cm), mean (min - max)	0.940 (0 - 3.50)	1.47 (0 - 4.3)	0.022
The maximum diameter of the lymph node (cm), mean (min - max)	1.20 (0 - 5)	1.13(0 - 7.1)	0.805

Table 2. The Characters and the Difference Between Enhanced CT and Pathology

Clinical characters

Pathology (%)

Enhanced CT (%)

P value

PrCR: complete response of the primary site; PLCR: complete response of the primary site and the lymph node; LCR: complete response of the lymph node; TR: tumor response; CT: computed tomography.

0.094

Mild

9 (22.0)

7 (17.1)

Moderate

7 (17.1)

22 (53.7)

Severe

25 (61.0)

12 (29.3)

PrCR

< 0.001

Yes

17 (41.5)

2 (4.9)

24 (58.5)

39 (95.1)

LCR

< 0.001

Yes

22 (53.7)

5 (12.2)

19 (46.3)

36 (87.8)

PLCR

< 0.001

Yes

13 (31.7)

0 (0)

28 (68.3)

41 (100)

The maximum diameter of the primary lesion (cm), mean (min - max)

0.940 (0 - 3.50)

1.47 (0 - 4.3)

0.022

The maximum diameter of the lymph node (cm), mean (min - max)

1.20 (0 - 5)

1.13(0 - 7.1)

0.805

**Table 3.** The Characters and the Difference Between Enhanced MR and Pathology
Clinical characters	Pathology (%)	Enhanced MR (%)	P value
PrCR: complete response of the primary site; PLCR: complete response of the primary site and the lymph node; LCR: complete response of the lymph node; TR: tumor response; MR: magnetic resonance.
TR			0.006
Mild	9 (22.0)	7 (17.1)
Moderate	7 (17.1)	27 (65.8)
Severe	25 (61.0)	7 (17.1)
PrCR			< 0.001
Yes	17 (41.5)	3 (7.3)
No	24 (58.5)	38 (92.7)
LCR			< 0.001
Yes	22 (53.7)	3 (7.3)
No	19 (46.3)	38 (92.7)
PLCR			< 0.001
Yes	13 (31.7)	0 (0)
No	28 (68.3)	41 (100)
The maximum diameter of the primary lesion (cm), mean (min - max)	0.940 (0 - 3.50)	1.82 (0 - 5.8)	< 0.001
The maximum diameter of the lymph node (cm), mean (min - max)	1.20 (0 - 5)	1.13(0 - 5.10)	0.779

Table 3. The Characters and the Difference Between Enhanced MR and Pathology

Clinical characters

Pathology (%)

Enhanced MR (%)

P value

PrCR: complete response of the primary site; PLCR: complete response of the primary site and the lymph node; LCR: complete response of the lymph node; TR: tumor response; MR: magnetic resonance.

0.006

Mild

9 (22.0)

7 (17.1)

Moderate

7 (17.1)

27 (65.8)

Severe

25 (61.0)

7 (17.1)

PrCR

< 0.001

Yes

17 (41.5)

3 (7.3)

24 (58.5)

38 (92.7)

LCR

< 0.001

Yes

22 (53.7)

3 (7.3)

19 (46.3)

38 (92.7)

PLCR

< 0.001

Yes

13 (31.7)

0 (0)

28 (68.3)

41 (100)

The maximum diameter of the primary lesion (cm), mean (min - max)

0.940 (0 - 3.50)

1.82 (0 - 5.8)

< 0.001

The maximum diameter of the lymph node (cm), mean (min - max)

1.20 (0 - 5)

1.13(0 - 5.10)

0.779

**Table 4.** The Multivariate Analysis of the Difference Between Enhanced CT and Pathology on TR
Clinical characters	Enhanced CT, OR (97.5%)	P value
ICIs: immune checkpoint inhibitors; CT: computed tomography; NLR: the ratio of neutrophils to lymphocytes; TR: tumor response; OR: odd ratio.
Gender, male	1.03 (0.013 - 84.7)	0.999
Age (years)	-0.94 (0.78 - 1.15)	0.998
Tumor type		< 0.001
Hypopharyngeal cancer	7.04 (0.35 - 141)
Oral cancer	3.64 (0.04 - 316)
Laryngeal cancer	-0.18 (0.0000103 - 3,294)
Multiple cancer		1.000
Yes	1.09 (0.023 - 51.4)
Differentiation	-0.907 (0.19 - 4.37)	0.999
High
Mid
Poor
T stage	-0.71 (0.17 - 3.01)	< 0.001
T1
T2
T3
T4a
Immunotherapy cycle	1.05 (0.14 - 7.79)	1.000
1
2
3
ICIs types	1.09 (0.14 - 7.76)	1.000
Pabolizumab
Triplimab
Tirellizumab
Sindilizumab
Blood routine parameters
NLR	2.05 (0.07 - 60.22)	< 0.001

Table 4. The Multivariate Analysis of the Difference Between Enhanced CT and Pathology on TR

Clinical characters

Enhanced CT, OR (97.5%)

P value

ICIs: immune checkpoint inhibitors; CT: computed tomography; NLR: the ratio of neutrophils to lymphocytes; TR: tumor response; OR: odd ratio.

Gender, male

1.03 (0.013 - 84.7)

0.999

Age (years)

-0.94 (0.78 - 1.15)

0.998

Tumor type

< 0.001

Hypopharyngeal cancer

7.04 (0.35 - 141)

Oral cancer

3.64 (0.04 - 316)

Laryngeal cancer

-0.18 (0.0000103 - 3,294)

Multiple cancer

1.000

Yes

1.09 (0.023 - 51.4)

Differentiation

-0.907 (0.19 - 4.37)

0.999

High

Mid

Poor

T stage

-0.71 (0.17 - 3.01)

< 0.001

T4a

Immunotherapy cycle

1.05 (0.14 - 7.79)

1.000

ICIs types

1.09 (0.14 - 7.76)

1.000

Pabolizumab

Triplimab

Tirellizumab

Sindilizumab

Blood routine parameters

NLR

2.05 (0.07 - 60.22)

< 0.001

**Table 5.** The Multivariate Analysis of the Difference Between Enhanced MR and Pathology on TR
Clinical characters	Enhanced MR, OR (97.5%)	P value
ICIs: immune checkpoint inhibitors; TR: tumor response; NLR: the ratio of neutrophils to lymphocytes; OR: odd ratio; MR: magnetic resonance.
Gender, male	1.25 (0.01 - 135.43)	0.999
Age (year)	-0.79 (0.61 - 1.02)	< 0.001
Tumor type		< 0.001
Hypopharyngeal cancer	22.81 (0.53 - 984.45)
Oral cancer	2.65 (0.02 - 314.12)
Laryngeal cancer	-0.0001 (5.0 - 26.09)
Multiple cancer		1.000
Yes	-0.72 (0.010 - 53.99)
Differentiation	1.52 (0.28 - 8.33)	0.999
High
Mid
Poor
T stage	-0.29 (0.05 - 1.73)	< 0.001
T1
T2
T3
T4a
Immunotherapy cycle	1.80 (0.19 - 16.99)	0.999
1
2
3
ICIs types	1.07 (0.18 - 15.94)	0.999
Pabolizumab
Triplimab
Tirellizumab
Sindilizumab
Blood routine parameters
NLR	19.47 (0.41 - 928.86)	< 0.001

Table 5. The Multivariate Analysis of the Difference Between Enhanced MR and Pathology on TR

Clinical characters

Enhanced MR, OR (97.5%)

P value

ICIs: immune checkpoint inhibitors; TR: tumor response; NLR: the ratio of neutrophils to lymphocytes; OR: odd ratio; MR: magnetic resonance.

Gender, male

1.25 (0.01 - 135.43)

0.999

Age (year)

-0.79 (0.61 - 1.02)

< 0.001

Tumor type

< 0.001

Hypopharyngeal cancer

22.81 (0.53 - 984.45)

Oral cancer

2.65 (0.02 - 314.12)

Laryngeal cancer

-0.0001 (5.0 - 26.09)

Multiple cancer

1.000

Yes

-0.72 (0.010 - 53.99)

Differentiation

1.52 (0.28 - 8.33)

0.999

High

Mid

Poor

T stage

-0.29 (0.05 - 1.73)

< 0.001

T4a

Immunotherapy cycle

1.80 (0.19 - 16.99)

0.999

ICIs types

1.07 (0.18 - 15.94)

0.999

Pabolizumab

Triplimab

Tirellizumab

Sindilizumab

Blood routine parameters

NLR

19.47 (0.41 - 928.86)

< 0.001