Squamous cell cancer of the head and neck (SCCHN) with distant metastasis at presentation

Abstract

6053 Background: SCCHN is confined to the head and neck region in the majority of patients at presentation. Unfortunately, some patients have distant metastasis at presentation and this has a significant effect on treatment and prognosis. Current literature reports a rate of distant metastatic disease at presentation between 1.5% and 16.8%. This is based on small studies which preclude a more comprehensive analysis. We have studied the Surveillance Epidemiology and End Results (SEER) database to determine the rate of and risk factors for distant disease at presentation. Methods: We have identified all patients with the diagnosis of SCCHN who are older than age 20 who have been diagnosed between 1988 and 2003. Patients whose disease extent is not evaluated have been excluded. Tumor sites evaluated include the lip, oral cavity, oropharynx, nasopharynx, sinus, hypopharynx, supraglottis, glottis, and subglottis. In addition, we have determined the effect of lymph node status and primary size on the rate of distant metastases at presentation. We arbitrarily chose a rate of >5% to be high risk for metastasis and a rate of <1% to be low risk. The results were analyzed with binomial confidence intervals. Results: Among the 76,925 patients identified, 2,312 (3.01%; 95% CI: 2.89%-3.13%) had distant metastasis at presentation. The rate of distant metastases increased in relation to tumor size and lymph node status. Tumors at high risk include lip, hypopharynx, supraglottic, glottic, and nasopharynx N2/N3; lymph node positive sinus tumors; oropharynx and oral cavity tumors N3 disease; and sinus, hypopharynx, and oropharynx tumors greater than 4 cm. Tumors with low risk of metastasis include lip, oral cavity, and glottic tumors that are either less than 2 cm or without lymph node involvement. Conclusion: Distant metastasis at presentation is an uncommon event for SCCHN. The primary site, tumor size, and nodal stage all help determine the patients that are at particularly high or low risk for presenting with Stage IVC disease. Site Total in SEER Number Metastatic at Presentation Percentage 95% CI Lip 5,975 20 0.33% 0.20–0.52% Oral Cavity 16,385 320 1.95% 1.75–2.18% Oropharynx 17,783 729 4.10% 3.81–4.40% Hypopharynx 1,866 128 6.86% 5.75–8.10% Supraglottis 8,114 270 3.33% 2.95–3.74% Glottis 13,085 87 0.66% 0.53–0.82% Subglottis 356 12 3.37% 1.75–5.81% Sinus 1,068 69 6.46% 5.06–8.11% Nasopharynx 2,610 177 6.78% 5.85–7.81% No significant financial relationships to disclose.