Major prognostic factors for recurrence and survival independent of the American Joint Committee on Cancer eighth edition staging system in patients with cutaneous squamous cell carcinoma treated with multimodality therapy

Xu, Melody J.; Lazar, Ann; Garsa, Adam A.; Arron, Sarah T.; Ryan, William R.; El‐Sayed, Ivan H.; George, Julia D.; Algazi, Alain P.; Heaton, Chase M.; Ha, Patrick K.; Yom, Sue S.

doi:10.1002/hed.25114

Cited by 31 publications

(28 citation statements)

References 21 publications

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“…It remains to be seen whether this staging system or additional variables, such as immunosuppression, in-transit metastasis, or genetic profiles, may improve prognostic stratification in patients with these tumors. 18…”

Section: Discussionmentioning

confidence: 99%

Institutional Experience of Treatment and Outcomes for Cutaneous Periauricular Squamous Cell Carcinoma

Kovatch¹,

Smith

Birkeland³

et al. 2019

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ObjectivesTo report our institutional experience, management, and outcomes of cutaneous periauricular squamous cell carcinoma (SCC).Study DesignRetrospective chart review.SettingTertiary academic center.SubjectsPatients undergoing treatment of cutaneous periauricular SCC from 2000 to 2016.ResultsA total of 112 patients had a median follow-up of 24.5 months, a mean ± SD age of 75.7 ± 10.6 years, and a strong male predominance (93.8%). Site distribution shows 87 (77.7%) auricular, 26 (23.2%) preauricular, and 10 (8.8%) postauricular lesions. Of auricular lesions, tumors involved the tragus (n = 3, 3.4%), helix/antihelix (n = 47, 54.0%), conchal bowl (n = 31, 35.6%), external auditory canal (n = 18, 16.1%), and lobule (n = 3, 3.4%). Most patients presented at stage I (52.7%) versus stages II (28.6%), III (6.3%), and IV (12.5%). Patients were largely treated surgically with primary tumor resection ranging from wide local excision to lateral temporal bone resection (± parotidectomy and neck dissection), with 17.0% and 5.4% receiving adjuvant radiation and chemoradiation, respectively. Metastatic spread was seen to the parotid (25.9%) and neck (26.8%), with most common cervical spread to level II. Overall survival, disease-specific survival, and disease-free survival at 3 years were 62%, 89%, and 56%, respectively. Nodal disease was associated with worse disease-specific survival (P < .001) and disease-free survival (P = .042). Pre- and postauricular sites were associated with worse overall survival (P = .007) relative to auricular sites.ConclusionAmong cutaneous SCC, periauricular subsites pose treatment challenges related to surrounding anatomy and represent a unique tumor population. The reported propensity toward recurrence and patterns of metastasis may better guide treatment of aggressive tumors to include regional nodal dissection.

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Section: Discussionmentioning

confidence: 99%

Institutional Experience of Treatment and Outcomes for Cutaneous Periauricular Squamous Cell Carcinoma

Kovatch¹,

Smith

Birkeland³

et al. 2019

OTO Open

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“…Risk increased with age, in males, in patients with immunosuppression, in higher deprivation quintiles, and location on the ear and lip [25]. Immunosuppression in patients with cSCC may include human immunodeficiency virus (HIV) infection, solid organ transplant, hӕmatopoietic stem cell transplant, or chronic lymphocytic leukemia (CLL) [38]. Several studies have shown worse outcomes for cSCC in immunosuppressed patients compared to immunocompetent patients [39,40].…”

Section: Prognosismentioning

confidence: 99%

European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 1. epidemiology, diagnostics and prevention

Stratigos

Garbe²,

Dessinioti

et al. 2020

European Journal of Cancer

172

233

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“…Our definitive surgical cohort showed an estimated 2-and 5-year DFS of 64% and 49%, respectively, despite 80% of patients receiving adjuvant treatment. Single-institution reviews have reported 5-year DFS and locoregional control rates from 59% to 78% 6,11,12,17,18,20 ; in a recent review of 101 patients receiving surgery and adjuvant RT for Bold type denotes statistical significance at p < .05. CI = confidence interval; ENE = extranodal extension; HR = hazard ratio; LVSI = lymphovascular space invasion; PD = poorly differentiated; PNI = perineural invasion; RT = radiation therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Those are based mostly on single-institution reviews, as there are no national cancer registries that currently track the outcomes of cSCC. Risk factors for HNcSCC reportedly associated with worse outcomes include: advanced age, 6,7 size/diameter, 4,5,8,9 depth of invasion, 4,5,9 perineural invasion (PNI), 4,5,10,11 location, 5 poorly differentiated histology, 4,5,9,12,13 recurrent disease, 4 extranodal extension (ENE) of lymph nodes, 7,8,14,15 lymph node ratio, 6,16,17 immunosuppression, 6,11,[14][15][16][18][19][20] positive margins, 13,15,19,21 parotid metastases, 19,22 and disease-free interval. 23 Although many of these have been taken into consideration in the American Joint Committee on Cancer (AJCC) 8th Edition staging of HNcSCC, several others have been omitted.…”

Section: Introductionmentioning

confidence: 99%

High‐Risk Cutaneous Squamous Cell Cancer of the Head and Neck: Risk Factors for Recurrence and Impact of Adjuvant Treatment

et al. 2020

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Objectives The behavior of advanced cutaneous squamous cell carcinoma of the head and neck (HNcSCC) remains poorly understood, with highly variable risk factors and a paucity of data for adjuvant treatment. The objective of our study was to review the oncologic outcomes of patients with high‐risk HNcSCC treated with surgery and to identify risk factors for treatment failure. Study Design Retrospective cohort study. Methods Retrospective review of patients treated for HNcSCC with definitive surgery involving at least parotidectomy and neck dissection at a tertiary care academic center from 2011 to 2017 was conducted. The primary outcome was disease‐free survival (DFS). Results One‐hundred four patients with a median age of 68 years (range = 42–91 years) were reviewed. Twenty‐one patients were treated with surgery alone, 45 patients underwent adjuvant radiotherapy (RT), and 38 patients underwent adjuvant chemoradiotherapy (CRT). The 2‐year DFS for patients treated with surgery, surgery + RT, and surgery + CRT were 71%, 65%, and 58%, respectively, with no significant difference between the groups (P = .70). On multivariate analyses, tumor size (P = .006) and perineural invasion (PNI, P = .04) independently predicted recurrence. The addition of chemotherapy did not appear to improve DFS, neither for those patients with extranodal extension and/or positive margins (P = .93) nor for the entire cohort (P = .43). Conclusions Advanced HNcSCC has a high recurrence rate despite adjuvant treatment. Tumor size >2 cm was a strong independent risk factor for recurrence. Out of the traditional mucosal HNcSCC risk factors, PNI was most strongly associated with worse DFS. There was no observed survival benefit to the addition of chemotherapy. Level of Evidence 4. Laryngoscope, 131:E136–E143, 2021

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Major prognostic factors for recurrence and survival independent of the American Joint Committee on Cancer eighth edition staging system in patients with cutaneous squamous cell carcinoma treated with multimodality therapy

Abstract: In-transit metastasis was significantly associated with locoregional recurrence, OS, and cause-specific mortality. Efforts should be made to define in-transit metastasis in the staging system.

Cited by 31 publications

References 21 publications

Institutional Experience of Treatment and Outcomes for Cutaneous Periauricular Squamous Cell Carcinoma

Institutional Experience of Treatment and Outcomes for Cutaneous Periauricular Squamous Cell Carcinoma

European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 1. epidemiology, diagnostics and prevention

High‐Risk Cutaneous Squamous Cell Cancer of the Head and Neck: Risk Factors for Recurrence and Impact of Adjuvant Treatment

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