Prognostic markers in metastatic cutaneous squamous cell carcinoma of the head and neck

Hirshoren, Nir; Danne, Julia; Dixon, Benjamin J.; Magarey, Matthew; Kleid, Stephen; Webb, Angela; Tiong, Albert; Corry, June; Gyorki, David E.

doi:10.1002/hed.24683

Cited by 36 publications

(62 citation statements)

References 32 publications

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“…ENE was an exceedingly common feature, occurring in 77% of our cohort. This is consistent with previous literature on metastatic nodal cSCCHN from large series in Australia and New Zealand, with the incidence of ENE ranging between 57% and 85% . As a result of the high rates of ENE, application of AJCC8 nodal classification criteria resulted in 77% patients being upstaged.…”

Section: Discussionsupporting

confidence: 91%

“…This is consistent with previous literature on metastatic nodal cSCCHN from large series in Australia and New Zealand, with the incidence of ENE ranging between 57% and 85%. 11,[23][24][25] As a result of the high rates of ENE, application of AJCC8 nodal classification criteria resulted in 77% patients being upstaged. The majority of patients diagnosed as AJCC7 N1 were upstaged to AJCC8 N2a, and the majority of patients with AJCC7 N2 or N3 disease were upstaged to the new AJCC8 N3b classification.…”

Section: Discussionmentioning

confidence: 99%

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A critical analysis of the prognostic performance of the 8th edition American Joint Committee on Cancer staging for metastatic cutaneous squamous cell carcinoma of the head and neck

et al. 2019

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Background The 8th edition AJCC staging of cutaneous squamous cell carcinoma of the head and neck (cSCCHN) incorporated extranodal extension (ENE) for the first time. This study compared the prognostic performance of the 7th and 8th edition staging for cSCCHN with nodal metastases. Methods Retrospective analysis of 96 patients with metastatic cSCCHN, comparing the ability of staging systems to predict disease‐specific and overall survival (OS) using the proportion of variation explained and Harrell's C‐index. Results In AJCC8, the N classification was upstaged in 77% of patients due to the presence of ENE and 88% of patients were classified as TNM stage IV. AJCC8 was inferior to AJCC7 in predicting disease‐specific survival for both N and TNM stages, and OS by TNM stage. Conclusions The majority of patients with metastatic cSCCHN have ENE and are classified as TNM stage IV based on the 8th edition staging, resulting in poor prognostic performance.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

A critical analysis of the prognostic performance of the 8th edition American Joint Committee on Cancer staging for metastatic cutaneous squamous cell carcinoma of the head and neck

et al. 2019

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“…found an LNR >0.21 was an independent predictor of disease progression and reduced survival in their cohort of 238 patients, but did not analyse the number of nodal metastases. In another retrospective study of 149 patients, Hirshoren et al . found both the LNR and the number of metastatic lymph nodes predicted reduced overall survival on multivariate analysis.…”

Section: Discussionmentioning

confidence: 98%

“…The LNR expresses the ratio of involved lymph nodes to the total number of lymph nodes removed and has become a well‐recognized prognostic factor in many cancer types. Several studies have suggested the LNR is also an independent prognostic factor in metastatic cSCCHN . Tseros et al .…”

Section: Discussionmentioning

confidence: 99%

“…One factor that has received limited attention is the prognostic significance of the number of nodal metastases, with the literature to date reporting conflicting results . However, recent studies have shown that the lymph node ratio (LNR) is an independent prognostic factor in metastatic cSCCHN . This raises the possibility that the number of metastatic lymph nodes, the numerator in the LNR, may be of importance beyond the single versus multiple node distinction currently used in the American Joint Committee on Cancer (AJCC) nodal (N) staging system.…”

Section: Introductionmentioning

confidence: 99%

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Number of nodal metastases and prognosis in metastatic cutaneous squamous cell carcinoma of the head and neck

Sood

Wykes

Roshan

et al. 2019

ANZ Journal of Surgery

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Background Existing prognostic systems for metastatic cutaneous squamous cell carcinoma of the head and neck (cSCCHN) do not discriminate between the number of involved nodes beyond single versus multiple. This study aimed to determine if the number of metastatic lymph nodes is an independent prognostic factor in metastatic cSCCHN and whether it provides additional prognostic information to the American Joint Committee on Cancer (AJCC) staging. Methods We retrospectively analysed 101 patients undergoing curative intent treatment for metastatic cSCCHN to parotid and/or neck nodes by surgery +/− radiotherapy at Liverpool Hospital, Sydney, Australia. The impact of number of nodal metastases on disease‐free survival (DFS) and risk of distant metastases was assessed using multivariate Cox regression. Results The mean number of nodal metastases was 2.5 (range 1–12). On multivariate analysis, increasing number of nodal metastases significantly predicted reduced DFS (hazard ratio 1.17; 95% confidence interval 1.05–1.30; P = 0.004), with a 17% increased risk of recurrence or death for each additional node. This remained significant in multivariate models adjusted for AJCC 8th edition nodal and TNM stages. Number of nodal metastases was also associated with risk of distant metastatic failure (hazard ratio 1.21; 95% confidence interval 1.05–1.39; P = 0.009). Conclusion Increasing number of nodal metastases is associated with decreased DFS and increased risk of distant metastases in metastatic cSCCHN, with a cumulative risk increase with each additional node. It provides additional prognostic information to the AJCC staging, which may be improved by incorporating information on the number of nodal metastases beyond the current single versus multiple distinction.

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Outcomes of Cutaneous Squamous Cell Carcinoma in the Head and Neck Region With Regional Lymph Node Metastasis

Sahovaler

Krishnan

Yeh

et al. 2019

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE There is a need to summarize the available evidence and provide quantitative data of the most important prognostic factors for patients with metastatic cutaneous squamous cell carcinoma of the head and neck region with regional lymph node metastasis (McSCCHN). OBJECTIVE To undertake a PRISMA-compliant systematic review and meta-analysis of all published studies on the risk factors for overall survival (OS), locoregional control (LRC), locoregional recurrence (LRR), and disease-specific survival (DSS) for patients with McSCCHN.

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Prognostic markers in metastatic cutaneous squamous cell carcinoma of the head and neck

Abstract: Low total lymph node ratio is associated with improved outcomes in node-positive head and neck cutaneous SCC. © 2017 Wiley Periodicals, Inc. Head Neck 39: 772-778, 2017.

Cited by 36 publications

References 32 publications

A critical analysis of the prognostic performance of the 8th edition American Joint Committee on Cancer staging for metastatic cutaneous squamous cell carcinoma of the head and neck

A critical analysis of the prognostic performance of the 8th edition American Joint Committee on Cancer staging for metastatic cutaneous squamous cell carcinoma of the head and neck

Number of nodal metastases and prognosis in metastatic cutaneous squamous cell carcinoma of the head and neck

Outcomes of Cutaneous Squamous Cell Carcinoma in the Head and Neck Region With Regional Lymph Node Metastasis

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