Efficacy of radical resection following neoadjuvant targeted therapy combined with chemotherapy for locally advanced oral squamous cell carcinoma: a propensity score-matched retrospective cohort study

This retrospective cohort study evaluated the impact of two cycles of cetuximab plus nab-paclitaxel and cisplatin (TPE) neoadjuvant therapy followed by radical resection, compared with upfront surgery (UFS), on 2-year survival outcomes in locally advanced oral squamous cell carcinoma (OSCC). Clinical data from 750 OSCC patients admitted between October 2022 and October 2025 were retrospectively analyzed. Propensity score matching (age, sex, primary tumor site) yielded 27 patients per group. Objective response rate (ORR), pathological complete response (pCR), and adverse reactions were assessed. Kaplan-Meier and multivariate Cox regression analyses evaluated survival outcomes. All 27 TPE patients completed two cycles. ORR was 59.26% (complete response [CR] 11.11%, partial response [PR] 48.15%, stable disease [SD] 40.74%; no progressive disease [PD] observed). pCR rate was 22.22%. Common adverse reactions included alopecia (100%) and rash (88.9%), all grade 1–3; no grade 4 events, treatment-related deaths, dose reductions, or surgical delays occurred. Two-year overall survival was 80.0% (TPE) vs. 73.1% (UFS) ( P > 0.05); 2-year event-free survival was 74.8% vs. 66.7% ( P > 0.05). Subgroup analysis showed significantly longer event-free survival in objective responders versus SD patients ( P = 0.027). Multivariable Cox models showed neoadjuvant therapy did not reach significance for OS ( P = 0.283) or EFS ( P = 0.213). The TPE regimen demonstrated an acceptable safety profile in locally advanced OSCC. Patients achieving objective response may derive clinical benefit from TPE-based neoadjuvant therapy.