Metastatic cutaneous squamous cell carcinoma of the head and neck

Abstract

BACKGROUND:The authors propose a prognostic score model using a prospective study of patients with regional metastatic cutaneous squamous cell carcinoma of the head and neck.METHODS:Two‐hundred fifty patients were analyzed using a competing risks model to identify risk factors for survival. A risk score was obtained using the significant coefficients from the regression model, and cutoff points were determined that separated the score into 3 risk groups (low risk, moderate risk, and high risk).RESULTS:At a median follow‐up of 54 months (range, 1.3‐212 months) 70 of 250 patients (28%) developed recurrent disease: Most were regional recurrences (51 of 70 patients; 73%) in the treated lymph node basin. After regional recurrence, a majority (73%) died of disease. The following 4 variables were associated significantly with survival: immunosuppression (hazard ratio [HR], 3.13; 95% confidence interval [CI], 1.39‐7.05), treatment (HR, 0.32; 95% CI, 0.16‐0.66), extranodal spread (HR, 9.92; 95% CI, 1.28‐77.09), and margin status (HR, 1.85; 95% CI, 1.85‐3.369); and those 4 variables (immuosuppression, treatment, extranodal spread, and margin status) were used to calculate the ITEM score. The 5‐year risk of dying from disease for patients with high‐risk (>3.0), moderate‐risk (>2.6‐3.0), and low‐risk (≤2.6) ITEM scores were 56%, 24%, and 6%, respectively. Fifty‐six of 250 patients (22%) died from another cause.CONCLUSIONS:Patients who underwent surgery and received adjuvant radiotherapy had a better outcome compared with patients who underwent surgery alone. Patients who had moderate‐ or high‐risk ITEM scores, usually because of extranodal spread and involved excision margins, had a poor outcome. The authors recommend considering these patients for inclusion in adjuvant chemoradiotherapy trials. Cancer 2009. © 2009 American Cancer Society.

An Inflammatory Cytokine Milieu is Prominent in Premalignant Oral Lesions, but Subsides when Lesions Progress to Squamous Cell Carcinoma

“…Considerable attention has been given to assessing the systemic mechanisms mediating immune suppression in cancer patients such as those with HNSCC and, in particular, emphasis has been placed on measurement of immune inhibitory cytokines [22–25]. However, less is known about the intratumoral immune status and little is known about the immunological milieu in premalignant oral lesions.…”

Effects of Adjuvant Chemoradiotherapy on the Frequency and Function of Regulatory T Cells in Patients with Head and Neck Cancer

“…However, survival rates remain at less than 50% in HNSCC due to disease recurrence and the development of distant metastases (2). It has been suggested that CRT eliminates subsets of immune cells, thus reducing anti-tumor effector functions and contributing to disease recurrence (3).…”

Inferior outcomes in immunosuppressed patients with high-risk cutaneous squamous cell carcinoma of the head and neck treated with surgery and radiation therapy

“…[9][10][11][12] There are numerous case reports of cSCC of the head and neck (cSCC-HN) with virulent clinical courses, and studies have shown that immunosuppressed patients with cSCC-HN more frequently exhibit high-risk pathologic features. 9,10,[13][14][15][16][17][18] However, there is a paucity of data addressing comparative outcomes in this particular patient population. Whether recurrence risks are higher in immunosuppressed patients with cSCC-HN compared with immunocompetent patients is unclear.…”