Locoregional Recurrence Trends in Head and Neck Cutaneous Squamous Cell Carcinoma

Abstract

<h3>Purpose/Objective(s)</h3> Predictors of locoregional recurrence in head and neck cutaneous squamous cell carcinoma (HNCSCC) are poorly understood. Two staging methods are used to stratify recurrence and survival risk and including the American Joint Committee on Cancer (AJCC, 8^th edition) and the Brigham Women's Hospital (BWH) systems. Our objective was to compare the predictive 2-year locoregional recurrence rates between these systems. <h3>Materials/Methods</h3> A single-institution, retrospective review from 2015-2020 was conducted of patients who underwent resection of locally advanced HNCSCC. Data collected included patient age, sex, recurrence status, tumor features (location, grade, diameter, depth of invasion, perineural invasion, lymphovascular invasion), cervical nodal disease, AJCC and BWH staging, adjuvant radiation, and 2-year follow-up. Two-sided comparisons were made between those with and without locoregional recurrence. Separate Kaplan-Meier and Cox proportional hazard models were generated comparing AJCC T3-T4 disease and BWH T2b-T3 disease and analyzed using log-rank test. Significance determined at p<0.05. <h3>Results</h3> A total of 132 patients were included and were overwhelmingly male (90.0%) with mean age 70.9 ± 11.0 years. Of these, 26 experienced locoregional recurrence within 2 years from resection (19.7%). Those with recurrence were more likely to present with recurrent disease (73.1% vs. 24.5%, p<0.001), have higher grade (p=0.048), larger tumors (>2.0 cm, 79.2% vs. 43.5%, p=0.003) in high-risk locations (88.5% vs 55.7%, p=0.002) and receive adjuvant radiation (53.8% vs. 27.4%, p=0.018). No statistical difference was identified between age, sex, immunosuppression, lymphovascular or perineural invasion, or nodal disease. Kaplan-Meier curves comparing AJCC T3-T4 and BHW T3b-T3 disease demonstrated significant (p<0.001) and similar 2-year locoregional recurrence at 36.5% and 41.2%, respectively. Separate, multivariate Cox proportional hazard modeling of 2-year locoregional recurrence adjusting for recurrent disease and high-risk tumor location demonstrated hazard ratios (95% CI) of 2.73 (1.12-6.63) for AJCC T3-T4 disease and 5.02 (1.37-18.44) for BHW T2b-T3. <h3>Conclusion</h3> The BWH and AJCC staging systems have comparable 2-year locoregional recurrence rates after resection of HNCSCC. Controlled, prospective trials are required to further comparison.