Association between sex and survival in patients with head and neck spindle cell carcinoma

Abstract

Background Head and neck spindle cell carcinoma (HNSpCC) is a rare histological variant associated with worse outcomes. Our objective was to identify clinicopathological factors associated with survival in patients with HNSpCC compared to patients with conventional head and neck squamous cell carcinoma (HNSCC). Methods Using clinical data from the Surveillance, Epidemiology, and End Results database, we performed a survival analysis in patients with HNSpCC or HNSCC between 2004 and 2016. Results A total of 458 HNSpCC and 77 104 HNSCC were identified, including 17% and 16% female, respectively. Five‐year disease‐specific survival (DSS) was 63.90% and 73.90% in patients with HNSpCC and HNSCC, respectively. Sex (hazard ratio [HR] for females = 2.816; CI: 1.139–6.965; p = 0.025) was significantly associated with DSS in HNSpCC while no association was observed between sex and DSS in HNSCC. Conclusion HNSpCC in women is a specific subgroup of HNSCC, which is associated with a poor prognosis.

Prognostic significance of head and neck spindle cell carcinoma

“…One study of HNSpCC using the SEER registry identified an association between female sex and poorer DSS. 27 This finding was explained by the estradiol-induced overexpression of epithelial-mesenchymal transition (EMT) transcription factors and the deregulation of EMT-related microRNA, both of which contribute to HNSpCC carcinogenesis. 73,74 Interestingly, our study failed to detect significance between female sex and OS in multivariate analysis that included all HNSpCC cases.…”

“…3,5,6,20,35,36 Across all head and neck primary sites, patients with HNSpCC had higher-grade tumors, aligning well with existing literature. 6,27,30,37,38 The HR for death significantly varied by histology in multivariate analysis that included all HNSpCC and HNSCC cases. Multivariate analyses repeated within each primary site cohort, however, suggest that SpCC histology is not an independent prognostic factor when compared with conventional SCC for every head and neck primary site, supporting previous conclusions that SpCC and SCC may behave similarly.…”

“…Although site-specific comparisons of HNSpCC and HNSCC are scarce, oral cavity SpCC is considered to have greater potential for recurrence and metastasis than both oral cavity SCC and SpCC of other primary sites. 1,6,27,37,40 These associations persist in both early and advanced stages even when surgical resection yields negative margins on histologic examination. 3,13,41 Oral cavity SpCC also produces few early symptoms contributing to delayed presentation and discovery in more advanced stages.…”

“…The NCDB was queried from January 2004 through December 2017 to obtain cases of primary SpCC and SCC of the oral cavity, major salivary glands, sinonasal tract, oropharynx, hypopharynx, and larynx (Tables S1 and S2). 1,27,34 Anatomic site and histology codes were identified with the International Classification of Diseases for Oncology, Third Edition, First Revision (ICD-O-3.1). Patient data available for abstraction included age at diagnosis, sex, race, Charlson-Deyo comorbidity score (CDCS), Human Papillomavirus (HPV) status, history of prior malignancy, primary site, subsite, primary tumor diameter, grade, clinical American Joint Committee on Cancer (AJCC) 7th edition group stage, clinical tumornodal-metastasis (cTNM) classification, use of definitive surgery, radiotherapy, and chemotherapy, and surgical margin status.…”

“…1,6 Another study using the SEER registry found that oropharyngeal SpCC carries less mortality than oral cavity SpCC after adjusting for confounding variables. 27 Much of the remaining literature attempting to interpret the role of primary site within and between HNSpCC and HNSCC cohorts is limited to smaller case reports and series. 13,16,[28][29][30][31] Although several studies suggest that SpCC is associated with resistance to treatment, increased recurrence, and distant metastasis, it remains unclear if SpCC histology is an independent prognostic factor after adjusting for other variables that influence survival outcomes.…”