Abstract
PurposeTo 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).MethodsA 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.ResultsThe 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.ConclusionThis 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.
Highlights
Non-melanoma skin cancer is one of the most common malignancies worldwide, and the head and neck (HN) region is among the most frequently affected sites due to sun exposure
Few papers have analyzed the subgroup of cutaneous squamous cell carcinoma (cSCC) with nodes metastases (NM) [22,23,24], but primary tumor characteristics were not addressed [22], or study was limited to patients with intraparotid metastasis [23, 24] The primary objective of this study was to retrospectively analyze a cohort of patients affected by HN cSCC with intraparotid and/or cervical NM, and to clarify how primary tumor characteristics and pattern of regional disease presentation affect overall survival (OS)
A retrospective study on patients affected by neck and/or intraparotid NM from cSCC of the HN region was conducted at the Departments of Otorhinolaryngology—Head and Neck Surgery of the University of Brescia, Italy, and at the Integrated Oncology Center of Ana Nery Hospital, Santa Cruz do Sul, Brazil
Summary
Non-melanoma skin cancer is one of the most common malignancies worldwide, and the head and neck (HN) region is among the most frequently affected sites due to sun exposure. Whereas the vast majority of these tumors is represented by basal cell carcinoma (70–80% of cases), cutaneous squamous cell carcinoma (cSCC) accounts for nearly 20% of cases. In the United States, roughly 200,000–400,000 new cases of cSCC are diagnosed yearly. Approximately 40,000 cases present at advanced stages with an estimated 15,000 deaths each year [1]. A study from Nasser in 2011 found an incidence rate of cSCC in the Brazilian population of 120 cases/100,000 inhabitants, reaching a peak of 1484 cases/100,000 in males and 975 cases/100,000 in females aged 70 years or more [2].
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