{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:39:29Z","timestamp":1792604369242,"version":"4.5.0"},"reference-count":14,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp;amp; Neck"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate associations between obesity and pathologic response to neoadjuvant immune checkpoint inhibitors (ICI) in patients with head and neck squamous cell carcinoma (HNSCC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a retrospective cohort study conducted at a single tertiary academic center. We identified 42 patients with HNSCC treated with neoadjuvant ICI with or without chemotherapy. Obesity was defined as body mass index (BMI) \u2265\u200930\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . The primary outcome was any pathologic response (partial, major, or complete response). Multivariable logistic regression was performed to assess associations between obesity and response, adjusting for smoking status and Eastern Cooperative Oncology Group (ECOG) performance status. BMI was also analyzed as a continuous variable. Adjusted predicted probabilities of response were estimated across BMI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seven patients (17%) were obese. Obese patients had lower rates of pathologic response compared to non\u2010obese patients (29% vs. 69%). On multivariable analysis, obesity was associated with decreased odds of response (OR 0.10, 95% CI 0.02\u20130.72;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021). Increasing BMI was independently associated with lower odds of response, with a 15% decrease per 1\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      increase [OR 0.85 (0.72\u20130.99),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.039]. Adjusted predicted probability of response declined from ~85% at BMI 18 to 25% at BMI 40. In a subset of patients receiving immunotherapy alone, increasing BMI remained associated with decreased response [OR 0.66 (0.44\u20130.99),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.045].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In a small pilot cohort, obesity was associated with decreased pathologic response to neoadjuvant ICI in HNSCC. These findings contrast with the \u201cobesity paradox\u201d observed in recurrent\/metastatic settings and suggest the relationship between metabolic state and immunotherapy response may be context\u2010dependent. Further validation in larger cohorts is needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70505","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T10:51:34Z","timestamp":1792579894000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Obesity and Pathologic Response to Neoadjuvant Immunotherapy in Head and Neck Cancer: Preliminary Results From a Pilot Study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5658-6125","authenticated-orcid":false,"given":"Angeline A.","family":"Truong","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California  San Francisco California USA"},{"name":"Department of Microbiology and Immunology University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1264-0491","authenticated-orcid":false,"given":"Laura","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4111-9975","authenticated-orcid":false,"given":"Rex H.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5952-3402","authenticated-orcid":false,"given":"Xin","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiology and Biomedical Imaging University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyunseok","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8121-3726","authenticated-orcid":false,"given":"Ivan H.","family":"El\u2010Sayed","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan R.","family":"George","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4296-8944","authenticated-orcid":false,"given":"Chase M.","family":"Heaton","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California  San Francisco California USA"},{"name":"ENT Section, Department of Surgery San Francisco VA Medical Center  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilya","family":"Likhterov","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Chow","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4996-6362","authenticated-orcid":false,"given":"Mary Jue","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0306-6147","authenticated-orcid":false,"given":"Patrick K.","family":"Ha","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6576-4659","authenticated-orcid":false,"given":"Alain P.","family":"Algazi","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8180-4542","authenticated-orcid":false,"given":"Katherine C.","family":"Wai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California  San Francisco California USA"},{"name":"Department of Microbiology and Immunology University of California  San Francisco California 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