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. 2022 Mar;279(3):1573-1584.
doi: 10.1007/s00405-021-06944-w. Epub 2021 Jun 25.

Regional disease in head and neck cutaneous squamous cell carcinoma: the role of primary tumor characteristics and number of nodal metastases

Alberto Grammatica  1 , Michele Tomasoni  2   3 , Milena Fior  2   3 , Emanuela Ulaj  2   3 , Tommaso Gualtieri  2   3 , Paolo Bossi  3   4 , Simonetta Battocchio  5 , Davide Lombardi  2 , Alberto Deganello  2   3 , Davide Mattavelli  2   3 , Piero Nicolai  6 , Fabio Girardi  7 , Cesare Piazza  2   3
Affiliations

Regional disease in head and neck cutaneous squamous cell carcinoma: the role of primary tumor characteristics and number of nodal metastases

Alberto Grammatica et al. Eur Arch Otorhinolaryngol. 2022 Mar.

Abstract

Purpose: To identify potential risk factors impacting on overall survival (OS) of patients affected by lymph node metastasis from cutaneous squamous cell carcinoma (cSCC) of the head and neck (HN), with special emphasis on primary tumor characteristics and pattern of nodal recurrence (intraparotid and/or cervical).

Methods: A bi-institutional retrospective study on consecutive patients affected by cervical and/or intraparotid NM from HN cSCC and surgically treated with curative intent from May 2010 to January 2020 was conducted. OS was considered the outcome of interest.

Results: The study included 89 patients (M:F = 3.4:1; median age, 78 years; range, 22-99). Among the primary tumor characteristics, the most relevant prognostic factors were diameter ≥ 4 cm (hazard ratio [HR] = 2.56, p = 0.010) and depth of infiltration ≥ 6 mm (HR = 3.54, p = 0.027). Cervical NM was associated with worse OS (HR = 2.09, p = 0.016) compared to purely intraparotid NM (5-year OS: 60.9% vs. 28.1%, p = 0.014). At multivariable analysis, age, immunosuppression, pT3-T4 categories and a high burden of nodal disease (> 2 NM) confirmed to be independent risk factors, whereas adjuvant radiotherapy was independently associated with better outcome.

Conclusion: This study confirms the association of several independent prognosticators related to the patient, primary tumor, and nodal burden status. Patients with cervical NM should be considered at risk for harboring a higher number of metastatic lymph nodes.

Keywords: Lymph node metastasis; Parotid; Prognosis; Skin cancer; Squamous cell carcinoma.

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Conflict of interest statement

Each one of the authors declare that he/she has no conflict of interest.

Figures

Fig. 1
Fig. 1
Kaplan Meier survival curve showing OS in the cohort of nodal metastatic patients. Median survival is depicted with the dashed line
Fig. 2
Fig. 2
Overall survival according to primary tumor most relevant characteristics: a primary tumor largest diameter according to the cut-off of 4 cm, b primary tumor depth of infiltration according to the cut-off of 6 mm, c absence or presence of primary tumor perineural invasion (PNI), and d pT category according to the 8th Edition of the AJCC-UICC TNM classification (12)
Fig. 3
Fig. 3
Overall survival according to a burden of nodal disease (low, ≤ 2 NM and high, > 2 NM), and b localization of regional metastasis (exclusive intraparotid, exclusive cervical, and both intraparotid and cervical)
Fig. 4
Fig. 4
Role of adjuvant radiotherapy, with/without concurrent chemotherapy, in relation to overall survival
See this image and copyright information in PMC

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