Tumoral Skin Invasion Is an Independent Predictor of Rapid Recurrence in Head and Neck Cancer

Background Head and neck squamous cell carcinoma (HNSCC) is an aggressive malignancy, with 50% of patients recurring. A subset of patients experience rapid recurrence (RR) postoperatively but prior to adjuvant therapy. This study identifies factors associated with RR and additional recurrence intervals: short‐interval recurrence (SIR) and standard recurrence (SR). Methods Retrospective 10‐year review of 246 HNSCC patients undergoing surgery with adjuvant therapy. Recurrence was categorized as RR (prior to initiation of adjuvant therapy), SIR (≤ 6 months post‐adjuvant therapy), and SR (> 6 months post‐adjuvant therapy). Univariate analysis (UVA), multivariate analysis (MVA), and machine learning Random Forest models were employed to identify predictors of each recurrence interval. Results Of the 246 patients, 89 recurred (45 SR, 27 SIR, 17 RR). On MVA, skin invasion (OR = 3.492, p = 0.039) was a unique predictor of RR. Random Forest feature importance also revealed skin invasion, along with nodal status, tobacco pack‐years, and tumor size as predictors with strong performance (accuracy 93%, AUC 0.96, F1 0.93). Conclusion Skin invasion is a unique independent predictor of RR, confirmed by two statistical models. These patients warrant further study.