Cutaneous squamous cell carcinoma (SCC) of the head and neck: Risk factors of overall and recurrence-free survival

doi:10.1016/j.ejca.2010.02.046

European Journal of Cancer

Volume 46, Issue 9, June 2010, Pages 1563-1572

https://doi.org/10.1016/j.ejca.2010.02.046 Get rights and content

Abstract

Background

Head and neck cutaneous squamous cell carcinoma (HNCSCC) although rarely fatal has significant adverse public health effects due to high medical costs, compromised quality of life, functional impairment and other serious consequences. The present longitudinal cohort study of HNCSCC was designed to determine whether certain clinical–pathologic features of HNCSCC are associated with reduced overall and recurrence-free survival, as suggested by previous data.

Patients

The cohort sample consisted of 315 consecutive patients presenting with primary HNCSCC of the head and neck. Life-table analysis and Kaplan–Meier survival analysis were performed. Multivariate Cox’s proportional hazards regression models were used to assess the effects of covariates on the length of the interval.

Results

There were 145 male and 170 female Caucasian patients. At the time of analysis, 222 patients were alive. The mean follow-up time of a patient after enrolment has been 46.7 months (range, 12–124 months). Broder’s differentiation grade, perineural involvement, the presence of inflammation and T-stage were independent adjusted predictors for overall survival. pT and N-stage, inflammation and perineural involvement were significant predictors for recurrence-free survival while adjuvant irradiation was associated with a 92% reduced risk for recurrence. Life-table analysis showed that 87% and 69% study patients were free from recurrence at years 3 and 5, respectively.

Conclusions

Certain clinico-pathological predictors can be used to discriminate subsets of high-risk patients that could benefit from long-term follow-up. After excision in negative margins, patients with HNCSCC should be referred to specialised multidisciplinary oncology clinics for counselling on adjuvant radiotherapy and follow-up.

Introduction

Non-melanoma skin cancer (NMSC) is the commonest cancer in Caucasians. Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) constitute nearly all NMSC; the incidence of these tumours is rising.1, 2, 3, 4 Cutaneous SCC has an incidence of 16/100,000 people in Europe and of 356/100,000 sun-exposed Caucasians in the US.⁵ At least 75% of cutaneous SCC arises in the head and neck.5, 6 Head and neck cutaneous squamous cell carcinoma (HNCSCC) although rarely fatal has significant adverse public health effects due to high medical costs and, in advanced or aggressive cases, compromised quality of life from devastating aesthetic and psychosocial sequelae, functional impairment and other serious consequences.1, 7, 8 Histological diagnosis (tumour differentiation, depth of invasion, perineural involvement, size (horizontal dimension/diameter)) and immune status of the patients all have a role in predicting the risk of recurrence and metastasis. Other parameters such as the presence of inflammation are not well studied.⁸ Most patients are at low risk (<5%) of developing metastasis to regional lymph nodes. Clinicians often under-appreciate patients with unfavourable clinico-pathological factors such as the ones mentioned above but these patients remain at high risk of developing metastatic lymph node disease and dying.6, 9 Standard treatment modalities include wide local excision (WLE) with, or without regional control (neck dissection, ND), radiotherapy (XRT) and chemotherapy (CHT).6, 10, 11 These modalities may be combined to treat aggressive tumours.7, 11 The present longitudinal cohort study of HNCSCC was designed to determine whether certain clinical–pathologic features of HNCSCC are associated with reduced overall and recurrence-free survival, as suggested by previous data.

Section snippets

Patients

The cohort sample consisted of 387 consecutive patients presenting with primary HNCSCC of the head and neck between January 1996 and December 2006 in a tertiary referral cancer hospital. Institutional Review Board approval was waived due to the observational nature of the study. According to the Unit protocol follow-up was on a monthly basis for the first year, on a bimonthly basis for the second year, on a quarterly basis for the third year, a 6-monthly basis for the fourth and fifth year and

Demographics

Between January 1996 and December 2006, 387 patients presented with cutaneous HNCSCC of the head and neck. Forty-seven of these patients were ineligible for the study because they presented with recurrent tumours, in situ disease or did not receive treatment in our department, and 25 patients were excluded due to an inadequate follow-up. This left 315 patients with at least one HNCSCC lesion on presentation, definite treatment with curative intent and a minimum of 12 months of follow-up who were

Discussion

Cause of death was not specifically recorded in this study. However, the high association between mortality and recurrence observed in the study imply that most deaths in the cohort could be attributed to HNCSCC and its sequelae.

Known risk factors for the recurrence of cutaneous SCCs are treatment modality, tumour size >2 cm, depth of invasion >4 mm, poor histological differentiation, location on the ear, perineural involvement, location within scars or chronic inflammation, treatment failure and

Conflict of interest statement

None declared.

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Cutaneous squamous cell carcinoma (SCC) of the head and neck: Risk factors of overall and recurrence-free survival

Abstract

Background

Patients

Results

Conclusions

Introduction

Section snippets

Patients

Demographics

Discussion

Conflict of interest statement

Lancet Oncol

Lancet

Trends Mol Med

Mortality risk from squamous cell skin cancer

J Clin Oncol

Metastatic cutaneous squamous cell carcinoma of the head and neck: the immunosuppression, treatment, extranodal spread, and margin status (ITEM) prognostic score to predict outcome and the need to improve survival

Cancer

Clinical prognostic factors in stage I head and neck squamous cell carcinoma

J Craniofac Surg