Abstract
PurposeDistant metastasis (DM) in patients with head and neck squamous cell carcinoma (HNSCC) is uncommon, but strongly deteriorates prognosis. Controversy exists regarding age as a predictor for the presence and development of DM. The aim of this study was to investigate age and other predictors for DM in HNSCC patients.MethodsFrom 1413 patients diagnosed with a primary HNSCC between 1999 and 2010 in a tertiary referral centre, patient, disease and pathological characteristics were extracted from patient files. Uni- and multivariable Cox regression analyses were performed to identify risk factors for DM as primary outcome.ResultsDM occurred in 131 (9.3%) patients, of which 27 (1.9%) were diagnosed simultaneously with the primary tumour, 27 (1.9%) were diagnosed synchronous, and 77 (5.4%) were diagnosed metachronous. The most common site of DM was lung (51.1%), followed by bone (19.1%) and liver (11.5%). Multivariable analysis identified male gender (HR = 1.95, 95% CI 1.23–3.10) hypopharyngeal tumours (HR = 3.28, 95% CI 1.75–6.14), advanced T-stage (HR = 1.61, 95% CI 1.09–2.38), poor differentiation grade (HR = 2.49, 95% CI 1.07–5.78), regional lymph node metastasis (HR = 5.35, 95% CI 3.25–8.79) and extranodal extension of regional lymph nodes metastasis (HR = 3.06, 95% CI 1.39–6.72) as independent prognostic factors for the presence or development of DM. No relation with age was found.ConclusionAge is not related to the presence or development of DM. This study emphasizes the importance of screening for DM, especially in males, patients with hypopharyngeal tumours, advanced T-stage, histopathological poor differentiation grade, regional lymph node metastasis and extranodal extension.
Highlights
In patients with head and neck squamous cell carcinoma (HNSCC), the incidence of distant metastasis (DM) varies between 3 and 52% [1,2,3,4,5,6,7,8,9]
The most common primary tumour site was the larynx, most DM originated from the oropharynx (38.9%), followed by the hypopharynx (25.2%), larynx (24.4%) and oral cavity (11.5%)
Most primary tumours were diagnosed as a T1 tumour, which had the lowest DM incidence rate (7.6%)
Summary
In patients with head and neck squamous cell carcinoma (HNSCC), the incidence of distant metastasis (DM) varies between 3 and 52% [1,2,3,4,5,6,7,8,9]. The development of DM in HNSCC patients results in an infaust prognosis in most of the cases. Patients that are diagnosed with DM prior to treatment are withheld form intensive curative treatment. Approximately 11% patients undergo treatment with curative intent and are shortly afterwards diagnosed with DM [14]. In retrospect, these patients are unnecessarily treated with major consequences for quality of life and healthcare costs [5]. Routine screening for DM in all HNSCC patients does not seem rational, because of low incidence of DM in HNSCC patients
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