Neck management in metastatic cutaneous squamous cell carcinoma of the head and neck

Abstract

Objective: Optimal neck management remains unclear in head and neck cutaneous squamous cell carcinoma (HNcSCC) with parotid metastasis. Our goal was to compare the impact of different cervical treatments on HNcSCC with parotid metastasis.

Methods: Patients were retrospectively included. The primary outcome variables were regional control (RC) and disease-specific survival (DSS). The impacts of observation, elective neck irradiation (ENI), and elective neck dissection (END) were analyzed using the Cox model and presented as hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: In total, 268 patients were enrolled. In the Cox model for RC, compared with ENI, observation was associated with a significantly higher risk of regional recurrence (p = 0.001, HR = 2.50, 95%CI = 1.45-4.30). However, END showed a comparable influence on regional recurrence (p = 0.246, HR = 0.70, 95%CI = 0.38-1.28). In the Cox model for DSS, END demonstrated a similar HR of 0.62 (95%CI = 0.30-1.26) compared to ENI (p = 0.184). However, patients who underwent observation were associated with an additional nearly twofold risk of cancer-related mortality (HR = 2.85, 95%CI = 1.55-5.23). Subgroup analysis showed that ENI predicted comparable RC (p = 0.389) and DSS (p = 0.346) in patients with one or two metastatic parotid lymph nodes, but worse RC (p = 0.007) and DSS (p = 0.024) in patients with more than three positive lymph nodes.

Conclusion: In HNcSCC with parotid metastasis, elective treatment of neck lymph nodes with END or ENI should always be performed.

Keywords: elective neck dissection; elective neck irradiation; head and neck cutaneous squamous cell carcinoma; observation; parotid lymph node.

Figure 1

Flowchart of the three groups. HNcSCC, head neck cutaneous squamous cell carcinoma; END, elective neck dissection; ENI, elective neck irradiation.

Figure 2

Comparison of regional control (RC) between the elective neck dissection (END) and elective neck irradiation (ENI) groups stratified by positive parotid lymph nodes (LNs), deep lobe involvement, tumor stage, and extranodal extension (ENE) of the parotid LN.

Figure 3

Comparison of disease-specific survival (DSS) between the elective neck dissection (END) and elective neck irradiation (ENI) groups stratified by positive parotid lymph nodes (LNs), deep lobe involvement, tumor stage, and extranodal extension (ENE) of the parotid LN.