Regional Metastasis in Head and Neck Cutaneous Squamous Cell Carcinoma: An Update on the Significance of Extra-Nodal Extension and Soft Tissue Metastasis

Hasmat, Shaheen; Mooney, Craig P; Gao, Kan; Ebrahimi, Ardalan; Ch’ng, Sydney; Gupta, Ruta; Low, Tsu-Hui Hubert; Clark, Jonathan

doi:10.1245/s10434-020-08252-9

Cited by 14 publications

(13 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Soft tissue metastases, which were defined as free soft tissue tumor deposits lacking continuity with the primary tumor and without discernible associated lymph node tissue, were also classified as ENE positive, based on data suggesting the prognostic impact is similar to ENE. 15 Although the TNM staging system incorporates data on the primary (T) tumor by convention, there is evidence to suggest that in the subset of HNcSCC patients with lymph node metastases, this is the key determinant of prognosis rather than the primary features or T category. 14,16,17 In addition, only a minority of patients present with concurrent primary and nodal metastatic HNcSCC, 14 and details on the index primary are often not available at the time nodal metastases present, most often in patients with multiple previous HNcSCC's where several primaries may have been responsible.…”

Section: Discussionmentioning

confidence: 99%

A critical analysis of the 8th edition TNM staging for head and neck cutaneous squamous cell carcinoma with lymph node metastases and comparison to N1S3 stage and ITEM risk score: A multicenter study

Ebrahimi

Luk

Low

et al. 2021

Journal of Surgical Oncology

Self Cite

View full text Add to dashboard Cite

Background and Objectives: We performed a critical analysis of the 8th edition American Joint Committee on Cancer (AJCC) staging for head and neck cutaneous squamous cell carcinoma (HNcSCC) with nodal metastases and compared the performance to the N1S3 and ITEM systems. Methods: Multicenter study of 990 patients with metastatic HNcSCC treated with curative intent. The end points of interest were disease-specific (DSS) and overall survival (OS). Model fit was evaluated using Harrell's Concordance Index (C-index), proportion of variation explained (PVE), Akaike information criterion, and Bayesian information criterion. Results: N1S3 and ITEM demonstrated good distribution into risk categories in contrast to the AJCC system, which classified the majority (90.6%) of patients as N2-3 and Stage IV due to the high rate of extranodal extension. The N2c and N3a categories appeared redundant. There was considerable discordance between systems in risk allocation on an individual patient basis. N1S3 was the best performed (DSS: C-index 0.62, PVE 10.9%; OS: C-index 0.59, PVE 4.5%), albeit with relatively poor predictive value. Conclusions: The AJCC N category and tumor node metastasis stage have poor patient distribution and predictive performance in HNcSCC. The AJCC stage, N1S3, and ITEM score all provide limited prognostic information based on objective measures highlighting the need to develop a staging system specific to HNcSCC. K E Y W O R D S cancer staging, cutaneous squamous cell carcinoma, head and neck cancer, lymph node metastasis, prognosis How to cite this article: Ebrahimi A, Luk PP, Low H, et al. A critical analysis of the 8th edition TNM staging for head and neck cutaneous squamous cell carcinoma with lymph node metastases and comparison to N1S3 stage and ITEM risk score: A multicenter study.

show abstract

Section: Discussionmentioning

confidence: 99%

A critical analysis of the 8th edition TNM staging for head and neck cutaneous squamous cell carcinoma with lymph node metastases and comparison to N1S3 stage and ITEM risk score: A multicenter study

Ebrahimi

Luk

Low

et al. 2021

Journal of Surgical Oncology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Among the various clinical risk factors associated with ESCC pathogenesis, lymph node metastasis significantly contribute to poor prognosis, with the overall 5-year survival rates post-surgery dropping from 70–92% to 18–47% in patients with LNM [ 48 ]. Hence, the accurate identification of the LNM status, by imaging and molecular approaches, plays a crucial role in determining treatment strategies as well as prognostic outcomes [ 49 ].…”

Section: Metastatic Dissemination Routes Of Uadt Sccmentioning

confidence: 99%

ECM Remodeling in Squamous Cell Carcinoma of the Aerodigestive Tract: Pathways for Cancer Dissemination and Emerging Biomarkers

Fejza

Camicia

Poletto

et al. 2021

Cancers

View full text Add to dashboard Cite

Squamous cell carcinomas (SCC) include a number of different types of tumors developing in the skin, in hollow organs, as well as the upper aerodigestive tract (UADT) including the head and neck region and the esophagus which will be dealt with in this review. These tumors are often refractory to current therapeutic approaches with poor patient outcome. The most important prognostic determinant of SCC tumors is the presence of distant metastasis, significantly correlating with low patient survival rates. Rapidly emerging evidence indicate that the extracellular matrix (ECM) composition and remodeling profoundly affect SSC metastatic dissemination. In this review, we will summarize the current knowledge on the role of ECM and its remodeling enzymes in affecting the growth and dissemination of UADT SCC. Taken together, these published evidence suggest that a thorough analysis of the ECM composition in the UADT SCC microenvironment may help disclosing the mechanism of resistance to the treatments and help defining possible targets for clinical intervention.

show abstract

“…1 The presence of ENE has been associated with a higher rate of regional recurrence, distant metastasis, and poor survival. 2 This led to the incorporation of ENE in the eighth edition (2018) of the American Joint Committee on Cancer (AJCC) lymph node classification system (the AJCC Cancer Staging Manual, eighth edition [AJCC 8]). 3 Similar to the pathologic lymph node (pN) classification of oral and human papillomavirus-negative oropharyngeal squamous cell carcinoma (SCC), in patients with cutaneous SCC of the head and neck (HNSCC), the presence of ENE results in upstaging of the lymph node classification.…”

Section: Introductionmentioning

confidence: 99%

“…Extranodal extension (ENE), defined as extension of cancer cells through the lymph node capsule, has emerged as an independent indicator of disease aggressiveness in multiple malignancies 1 . The presence of ENE has been associated with a higher rate of regional recurrence, distant metastasis, and poor survival 2 . This led to the incorporation of ENE in the eighth edition (2018) of the American Joint Committee on Cancer (AJCC) lymph node classification system (the AJCC Cancer Staging Manual , eighth edition [AJCC 8]) 3 .…”

Section: Introductionmentioning

confidence: 99%

Inclusion of extranodal extension in the lymph node classification of cutaneous squamous cell carcinoma of the head and neck

Amit

Liu

Gleber‐Netto

et al. 2020

Cancer

View full text Add to dashboard Cite

BACKGROUND:The prognostic performance of the recently updated American Joint Committee on Cancer lymph node classification of cutaneous head and neck squamous cell carcinoma (HNSCC) has not been validated. The objective of this study was to assess the prognostic role of extranodal extension (ENE) in cutaneous HNSCC. METHODS: This was a retrospective analysis of 1258 patients with cutaneous HNSCC who underwent surgery with or without adjuvant therapy between 1995 and 2019 at The University of Texas MD Anderson Cancer Center. The primary outcome was disease-specific survival (DSS). Local, regional, and distant metastases-free survival were secondary outcomes. Recursive partitioning analysis (RPA) and a Cox proportional hazards regression model were used to assess the fitness of staging models. RESULTS: No significant differences in 5-year DSS were observed between patients with pathologic lymph node-negative (pN0) disease (67.4%) and those with pN-positive/ENE-negative disease (68.2%; hazard ratio, 1.02; 95% CI, 0.61-1.79) or between patients with pN-positive/ENE-negative disease and those with pN-positive/ENE-positive disease (52.7%; hazard ratio, 0.57; 95% CI, 0.31-1.01). The RPA-derived model achieved better stratification between high-risk patients (category III, ENE-positive with >2 positive lymph nodes) and low-risk patients (category I, pN0; category II, ENE-positive/pN1 and ENE-negative with >2 positive lymph nodes). The performance of the RPA-derived model was better than that of the pathologic TNM classification (Akaike information criterion score, 1167 compared with 1176; Bayesian information criterion score, 1175 compared with 1195). CONCLUSIONS: The number of metastatic lymph nodes and the presence of ENE are independent prognostic factors for DSS in cutaneous HNSCC, and incorporation of these factors in staging systems improves the performance of the American Joint Committee on Cancer lymph node classification.

show abstract

Regional Metastasis in Head and Neck Cutaneous Squamous Cell Carcinoma: An Update on the Significance of Extra-Nodal Extension and Soft Tissue Metastasis

Cited by 14 publications

References 17 publications

A critical analysis of the 8th edition TNM staging for head and neck cutaneous squamous cell carcinoma with lymph node metastases and comparison to N1S3 stage and ITEM risk score: A multicenter study

A critical analysis of the 8th edition TNM staging for head and neck cutaneous squamous cell carcinoma with lymph node metastases and comparison to N1S3 stage and ITEM risk score: A multicenter study

ECM Remodeling in Squamous Cell Carcinoma of the Aerodigestive Tract: Pathways for Cancer Dissemination and Emerging Biomarkers

Inclusion of extranodal extension in the lymph node classification of cutaneous squamous cell carcinoma of the head and neck

Contact Info

Product

Resources

About