Predictors of distant metastatic recurrence in head and neck cutaneous squamous cell carcinoma with lymph node metastases treated with curative intent: A multicenter study

Ardalan Ebrahimi; Ruta Gupta; Lachlan McDowell; Matthew J R Magarey; Paul N Smith; Klaus-Martin Schulte; Diana M Perriman; Michael Veness; Sandro Porceddu; Tsu-Hui Hubert Low; Allan Fowler; Jonathan R Clark

doi:10.1002/hed.27912

Predictors of distant metastatic recurrence in head and neck cutaneous squamous cell carcinoma with lymph node metastases treated with curative intent: A multicenter study

Head Neck. 2024 Aug 9. doi: 10.1002/hed.27912. Online ahead of print.

Authors

Ardalan Ebrahimi^{1

2

3}, Ruta Gupta^{4

5}, Lachlan McDowell^{6

7}, Matthew J R Magarey^{8

9}, Paul N Smith¹, Klaus-Martin Schulte¹, Diana M Perriman¹, Michael Veness^{5

10}, Sandro Porceddu^{11

12}, Tsu-Hui Hubert Low^{2

5}, Allan Fowler¹³, Jonathan R Clark^{2

5

14}

Affiliations

¹ Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia.
² Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
³ Department of Head and Neck Surgery, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.
⁴ Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁵ Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.
⁶ Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
⁷ Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.
⁸ Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
⁹ Department of Medical Education, University of Melbourne, Melbourne, Victoria, Australia.
¹⁰ Department of Radiation Oncology, Westmead Hospital, Sydney, New South Wales, Australia.
¹¹ Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
¹² School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
¹³ Department of Radiation Oncology, Liverpool Hospital, Sydney, New South Wales, Australia.
¹⁴ Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia.

PMID: 39119874
DOI: 10.1002/hed.27912

Abstract

Background: We aimed to identify predictors of distant metastatic recurrence (DMR) in patients with head and neck cutaneous squamous cell carcinoma (HNcSCC) with nodal metastases treated with curative intent.

Methods: Predictors of DMR were identified using Cox regression in a multicenter study of 1151 patients.

Results: The 5-year risk of DMR was 9.6%. On multivariate analysis, immunosuppression (HR 2.93; 95% CI: 1.70-5.05; p < 0.001), nodal size >6 cm [versus ≤3 cm (HR 2.77; 95% CI: 1.09-7.03; p = 0.032)], ≥5 nodal metastases [versus 1-2 (HR 2.79; 95% CI: 1.63-4.78; p < 0.001)], and bilateral disease (HR 3.11; 95% CI: 1.40-6.90; p = 0.005) predicted DMR. A DMR risk score was developed that stratified risk from 6.6% (no risk factors) to 100% (≥3 risk factors) (p < 0.001).

Conclusions: The risk of DMR in nodal metastatic HNcSCC increases with immunosuppression, nodal size >6 cm, ≥5 nodal metastases, and bilateral disease. A simple DMR risk score estimated prior to treatment may be clinically useful.

Keywords: cutaneous squamous cell carcinoma; distant metastases; head and neck cancer; lymph node metastasis; prognosis.