Objective:

To evaluate the association between patient-reported symptom scores and the risk of delayed hypoglossal nerve neuropathy in oropharyngeal cancer survivors, specifically focusing on the clinical implications of these scores.

Key Findings:

• Cumulative incidence of hypoglossal nerve neuropathy at 5 years was approximately 4%, highlighting the need for monitoring.
• Each 1-point increase in the MDASI-HN-NERVE score was associated with a 1.35-fold higher hazard of neuropathy, indicating a significant risk factor.
• Patients with baseline scores of at least 3.4 had lower neuropathy-free survival compared to those with lower scores, emphasizing the importance of early assessment.
• A single symptom item (speech/voice score of at least 2) indicated a 13.18-fold higher hazard of neuropathy, underscoring the predictive value of specific symptoms.

Interpretation:

The findings suggest that symptom-based surveillance using the MDASI-HN-NERVE score can help identify patients at higher risk for hypoglossal nerve neuropathy, although thresholds require external validation to confirm their reliability.

Limitations:

• Small number of confirmed neuropathy cases limited precision, and potential ascertainment bias due to symptom-informed diagnostic evaluations may affect the reliability of findings.

Conclusion:

Symptom scores may provide a practical approach for early detection and monitoring of CN XII neuropathy risk in oropharyngeal cancer survivors, potentially guiding clinical follow-up strategies.