Resting heart rate as a prognostic indicator for patients with head and neck squamous cell carcinoma

Background: Elevated resting heart rate (RHR) has been associated with poor prognosis in various cancers, but its significance in head and neck cancer (HNC) remains unclear. This study aimed to evaluate the prognostic impact of RHR and its association with the incidence of second primary cancer (SPC). Methods: We retrospectively analyzed 213 patients with oropharyngeal, hypopharyngeal, or laryngeal squamous cell carcinoma who underwent chemoradiotherapy. Pretreatment RHR was measured from electrocardiograms, and survival outcomes were analyzed using Kaplan-Meier and Cox regression models. Results: Patients with an RHR ≥ 83 bpm had significantly worse overall survival (P = 0.004) and disease-specific survival (P < 0.001). Elevated RHR was an independent prognostic factor and was associated with an increased incidence of SPC (P = 0.016), particularly esophageal cancer (P = 0.003). In exploratory analyses, this association with esophageal SPC remained after adjustment for alcohol consumption category and smoking status. Conclusions: RHR is a potential prognostic marker in HNC and, in exploratory analyses, was associated with an increased risk of SPCs, particularly esophageal cancer. These findings suggest that RHR may help stratify risk in patients with HNC, although further studies are needed to clarify its clinical implications.