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. 2012 Jan;19(1):274-9.
doi: 10.1245/s10434-011-1986-7. Epub 2011 Aug 9.

Cutaneous head and neck squamous cell carcinoma with regional metastases: the prognostic importance of soft tissue metastases and extranodal spread

Wendy Kelder  1 , Ardalan Ebrahimi, Veronique-Isabelle Forest, Kan Gao, Rajmohan Murali, Jonathan R Clark
Affiliations

Cutaneous head and neck squamous cell carcinoma with regional metastases: the prognostic importance of soft tissue metastases and extranodal spread

Wendy Kelder et al. Ann Surg Oncol. 2012 Jan.

Abstract

Background: Extranodal spread (ENS) is an established adverse prognostic factor in metastatic cutaneous squamous cell carcinoma (cSCC); however, the clinical significance of soft tissue metastases (STM) is unknown. The aim of this study was to evaluate the prognosis of patients with STM from head and neck cSCC, and to compare this with that of node metastases with and without ENS.

Methods: Patients with cSCC metastatic to the parotid and/or neck treated by primary surgical resection between 1987 and 2007 were included. Metastatic nodes >3 cm in size were an exclusion criterion. A Cox proportional hazard model was used to determine the effect of STM adjusting for other relevant prognostic factors.

Results: The population included 164 patients with a median follow-up of 26 months. There were 8 distant and 37 regional recurrences. There were 22 were cancer-specific deaths, and 29 patients died. STM was a significant predictor of reduced overall (hazard ratio 3.3; 95% confidence interval 1.6-6.4; P = 0.001) and disease-free survival (hazard ratio 2.4; 95% confidence interval 1.4-4.1; P = 0.001) when compared to patients with node disease with or without ENS. After adjusting for covariates, STM and number of involved nodes were significant independent predictors of overall and disease-free survival.

Conclusions: In metastatic cSCC of the head and neck, the presence of STM is an independent predictor of reduced survival and is associated with a greater adverse effect than ENS alone.

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Figures

Fig. 1
Fig. 1
STM of cutaneous SCC
Fig. 2
Fig. 2
Kaplan–Meier curves according to the presence or absence of STM for (a) overall survival and (b) disease-free survival
Fig. 3
Fig. 3
Cox proportional hazard regression comparing (a) overall survival and (b) disease-free survival, according to presence of ENS and STM versus STM alone versus ENS alone versus node disease without ENS or STM; adjusted by age, number of involved nodes and adjuvant radiotherapy
Fig. 4
Fig. 4
Cox proportional hazard regression comparing (a) overall survival and (b) disease-free survival, according to presence of STM alone versus ENS alone; adjusted by age and number of involved nodes
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