Parotid and cervical nodal status predict prognosis for patients with head and neck metastatic cutaneous squamous cell carcinoma

Sydney Ch'ng, Aloka Maitra, Robert S Allison, John M Chaplin, Reinhold T Gregor, Rodney Lea, Swee T Tan
Journal of Surgical Oncology 2008 August 1, 98 (2): 101-5

BACKGROUND AND OBJECTIVES: The appreciation of parotid involvement being an independent prognostic factor for metastatic cutaneous squamous cell carcinoma (SCC) is relatively new. A more comprehensive clinical staging system that separates parotid (P) from neck (N) disease, and further stratifies the N category has been proposed [O'Brien et al., Head Neck 2002; 24: 417-422]. This paper presents the clinical outcome of patients with head and neck metastatic cutaneous SCC treated at the four major head & neck surgical oncology centers in New Zealand and tests the proposed staging system, with modifications for pathological staging.

METHODS: Patients treated with a curative intent from 1990 to 2005 were identified and re-staged. Survival rates were calculated using the Kaplan-Meier method, and curves were compared with the log-rank test. Multivariate analysis using the Cox regression model was performed to assess the impact of each proposed P and N sub-group, and other parameters.

RESULTS AND CONCLUSIONS: One hundred and seventy patients were identified. The 5-year disease-specific survival rate was 69%, and the loco-regional recurrence rate was 36%. The presence of parotid (P < 0.01) or neck (P = 0.01) disease, immunosuppression (P < 0.01) and the uptake of radiotherapy (P < 0.01) impacted significantly on survival. Increasing P or N category worsened the prognosis significantly.

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