Neuroendocrine Carcinoma of the Head and Neck: A Two‐Decade Institutional Experience

Objectives Primary neuroendocrine carcinoma (NEC) of the head and neck is rare (< 1% of cases) and aggressive, with poorly defined management strategies. This study evaluated clinical characteristics, treatment patterns, and survival outcomes in a single‐institution cohort, identifying factors associated with improved survival. Methods A retrospective review was conducted of patients with head and neck NEC treated at a tertiary center. Variables associated with 3‐year overall survival (OS), disease‐specific survival (DSS), and recurrence‐free survival (RFS) were assessed using Cox regression and Kaplan–Meier curve analyses. Results Sixty‐nine patients (59.4% male, 95.7% White) were included. The most common subsites were sinonasal (36.2%) and laryngeal (30.4%). Most tumors were poorly differentiated (73.9%), and 50.7% were T category 3–4. Surgical resection was performed in 68.1% and primary radiotherapy or chemoradiotherapy in 20.3% of patients. Overall 3‐year OS and RFS were 55.5% and 56.1%, respectively. On multivariable analysis, surgery remained associated with improved 3‐year OS (adjusted hazard ratio [aHR]: 0.21, 95% CI: 0.06–0.66, p = 0.007) and DSS (aHR: 0.33, 95% CI: 0.11–0.99, p = 0.050) when controlling for tumor stage, histologic differentiation, tumor site, and age at diagnosis. Chemotherapy and radiotherapy were not associated with survival. Conclusions Head and neck NEC carries a poor prognosis. Undergoing surgical resection was strongly associated with improved 3‐year OS and DSS in our cohort, highlighting its importance when feasible. Multicenter collaboration and prospective studies are warranted to refine optimal treatment strategies for this rare and challenging malignancy.