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.
