Suboptimal Outcomes in Cutaneous Squamous Cell Cancer of the Head and Neck with Nodal Metastases

Anticancer Res. 2018 Oct;38(10):5825-5830. doi: 10.21873/anticanres.12923.

Abstract

Background/aim: There are limited data regarding survival, failure patterns, and factors associated with disease recurrence in patients with cutaneous squamous cell cancer of the head and neck (cSCC-HN) with nodal metastases.

Patients and methods: A retrospective analysis of patients with cSCC-HN metastatic to cervical and/or parotid lymph nodes treated with surgery and post-operative radiation therapy was performed.

Results: This study included 76 patients (57 immunocompetent and 18 immunosuppressed) with a median follow-up of 18 months. Overall survival, disease-free survival (DFS), and disease recurrence (DR) at 2 years was 60%, 49%, and 40%, respectively. Immunosuppressed patients had significantly lower 2-year DFS (28% vs. 55%; p=0.003) and higher DR (61% vs. 34%; p=0.04) compared to immunocompetent patients. Analysis of immunocompetent patients demonstrated extracapsular extension (ECE) as the only factor associated with DR (p<0.0001).

Conclusion: Patients with nodal metastases from cSCC-HN have suboptimal outcomes. ECE and immunosuppression were significantly associated with DR.

Keywords: Cutaneous squamous cell carcinoma; extracapsular extension; extranodal extension; head and neck; immunosuppression; nodal metastases; skin cancer.

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell / immunology
  • Carcinoma, Squamous Cell / mortality*
  • Carcinoma, Squamous Cell / secondary
  • Carcinoma, Squamous Cell / therapy
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Head and Neck Neoplasms / immunology
  • Head and Neck Neoplasms / mortality*
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / therapy
  • Humans
  • Immunocompromised Host*
  • Lymphatic Metastasis
  • Male
  • Neoplasm Invasiveness
  • Prognosis
  • Retrospective Studies
  • Skin Neoplasms / immunology
  • Skin Neoplasms / mortality*
  • Skin Neoplasms / secondary
  • Skin Neoplasms / therapy
  • Survival Rate