Objective <p>This study aimed to evaluate the impact of the postoperative pathological remission status on the prognosis of patients who underwent surgery after neoadjuvant immunochemotherapy in head and neck squamous cell carcinoma (HNSCC).</p> Methods <p>This study retrospectively analyzed patients who participated in a clinical trial at our hospital. These patients received neoadjuvant pembrolizumab combined with platinum and taxane followed by surgery from March 1, 2021, to November 1, 2024. Clinical and pathological characteristics were collected. Cox regression analysis was used to analyze clinical and pathological characteristics by univariate and multivariate analysis, and Kaplan Meier (KM) survival curves were plotted to evaluate the associations of clinical and pathological characteristics with the progression free survival (PFS) and overall survival(OS). Propensity score matching (PSM) was used to level the baseline of clinical characteristics.</p> Results <p>The study cohort consisted of a total of 62 patients. the PFS rate of the patients was 85.5%, and the OS rate was 87.1%. The follow-up period of the patients ranged from 4 to 41&#xa0;months, with an mean follow-up time of 23.7&#xa0;months. However, high pathological tumor response (PTR) was significantly associated with better OS (97.2% vs 70.8%) and was an independent prognostic factor ( hazard ratio 0.153; 95% Confidence interval 0.018 – 1.307, <i>p</i> = <i>0.046</i>). Before and after PSM, patients with high PTR had a significantly longer OS than those without high PTR (<i>p</i> = <i>0.0258,0.0053</i>).</p> Conclusion <p>Our study showed a strong OS improvement in patients who achieved high PTR after neoadjuvant immunochemotherapy.</p>