Prognostic significance of head and neck spindle cell carcinoma

Abstract

Background Our study investigates the prognostic significance of spindle cell histology on overall survival (OS) of conventional head and neck squamous cell carcinoma (HNSCC). Methods The 2004 to 2017 National Cancer Database was queried for patients with head and neck spindle cell carcinoma (HNSpCC) (n = 1572) or HNSCC (n = 242 697) of the oral cavity, major salivary glands, sinonasal tract, oropharynx, hypopharynx, and larynx treated with curative intent. Results Patients with HNSpCC presented more frequently with higher‐grade tumors and cN0 disease than those with HNSCC (p < 0.001). In the oral cavity, the HR for death for SpCC compared with SCC was 1.33 (p < 0.001). In the oropharynx, the HR for death for SpCC compared with SCC was 1.47 (p = 0.028). Conclusions After adjusting for patient, tumor, and treatment characteristics, SpCC histology had an independent adverse prognostic effect on OS in the oral cavity and oropharynx. SpCC histology does not necessarily portend poorer survival in all HNSCC. Level of Evidence: 4.

Surgical Resection Improves Overall Survival in cT4b Major Salivary Gland Cancer

“…Primary salivary SCC, for example, likely represents cutaneous metastasis subject to misclassification bias. 6,78,79 Classification criteria of MSGC are also heterogenous and continuously evolving, complicating retrospective analysis of longitudinal databases such as the NCDB. The NCDB does not report medical comorbidities, imaging studies, quality of life, tumor board recommendations, PNI, type of local involvement (eg, skull base extension or internal carotid artery encasement), and institutional protocols used to ascertain surgical margin status.…”

“…Limitations inherent in retrospective review of the NCDB include the possibility of inaccurate histologic diagnosis and variable miscoding. Primary salivary SCC, for example, likely represents cutaneous metastasis subject to misclassification bias 6,78,79 . Classification criteria of MSGC are also heterogenous and continuously evolving, complicating retrospective analysis of longitudinal databases such as the NCDB.…”

Patterns and Trends in Adjuvant Therapy for Major Salivary Gland Cancer

“…Primary salivary SCC, for example, may represent secondary metastatic lesions. 16,86 The NCDB does not reliably report medical comorbidities, tobacco use, history of neck irradiation, locoregional recurrence, adverse pathologic features, depth of invasion, facial nerve involvement, imaging studies, multidisciplinary tumor board recommendations, and quality of life data which should all be considered when determining the appropriateness of a potentially debilitating intervention such as adjuvant therapy. 44 Missed aRT is likely related to physician hesitancy in prescribing aggressive interventions, physicianpatient miscommunication, and inadequate social support, but variables necessary in making these inferences are also not encoded in the NCDB.…”

“…Limitations inherent in retrospective study of the NCDB include the possibility of inaccurate histologic diagnosis and variable miscoding. Primary salivary SCC, for example, may represent secondary metastatic lesions 16,86 . The NCDB does not reliably report medical comorbidities, tobacco use, history of neck irradiation, locoregional recurrence, adverse pathologic features, depth of invasion, facial nerve involvement, imaging studies, multidisciplinary tumor board recommendations, and quality of life data which should all be considered when determining the appropriateness of a potentially debilitating intervention such as adjuvant therapy 44 .…”

Unraveling a Histopathological Needle-in-Haystack Problem: Exploring the Challenges of Detecting Tumor Budding in Colorectal Carcinoma Histology

“…Furthermore, as the herein-described adaptions for small data sets are not limited to tumor budding at all, the approach could be used for small data sets of, for example, uncommon tumors. For example, to stay in the head and neck region, such approaches could be used for differentiating rare spindle cell lesions of the oral cavity, where at the end, undifferentiated sarcoma types need to be separated from spindle cell carcinoma [78][79][80][81].…”