Survival Outcomes for Advanced Cutaneous Squamous Cell Carcinoma of the Head and Neck

Abstract

Objectives: Survival outcomes for advanced non-melanoma skin cancers of the head and neck treated with surgical resection are not well described in the literature. We aimed to describe outcomes for T3 and T4 cutaneoous squamous cell carcinoma of the head or neck treated with surgical resection at 1 tertiary academic medical center. Methods: We analyzed a retrospective cohort of patients diagnosed with T3 or T4 cutaneous squamous cell carcinoma (SCC) of the head or neck from 2005 to 2016 treated with definitive surgical resection. Survival outcomes were examined using Kaplan-Meier analysis, and multivariate analysis was completed with Cox proportional hazard model. Results: Forty-three patients met inclusion criteria. The mean age at diagnosis was 74.7 years (SD = 10.2), and 34 (79.1%) patients were male. Twelve (27.9%) patients were immunosuppressed. Radical resection, defined as temporal bone resection, orbital exenteration, calvarial resection, mandibulectomy, or maxillectomy, was performed in 25 (58.1%) cases. Final surgical margins were positive in 19 (44.2%) cases. Patients with tumors of the scalp/neck had a 1-year survival probability of 85.7%, and the probability of survival 1 year after a neck dissection was greater than 93%. Conclusion: Anatomical subsites, specifically scalp/neck tumors, tended to have worse overall survival. Positive final margins tended to indicate a worse prognosis, and overall survival and recurrence were not significantly different among patients who underwent radical surgical resection compared to soft tissue resection.

Parotidectomy and neck dissection in locally advanced and relapsed cutaneous squamous cell carcinoma of Head and Neck Region

“…In 75% of patients, the main surgery was total primary resection with reconstruction followed by exenteration and temporalectomies, showing an aggressive presentation, similar to other developing countries 35 . Our data did not find an association between the type of primary surgery and survival, unusual since such a correlation is expected, however, there is comparable studies 34,38,39 .…”

“…In univariate and multivariate analysis, primary tumor site, histopathological characteristics and margins did not affect the OS, attributed to retrospective data bias [33][34][35] . Interestingly, our study found 90.5% of patients with comorbidities (20% immunosuppressed due transplant organ), having main role on developing progressively metastases from primary to parotid/neck [36][37][38] .…”

Benchmarking Survival Outcomes Following Surgical Management of pT3 and pT4 Cutaneous Squamous Cell Carcinoma of the Head and Neck

“…7,13 This probably reflects differential local referral patterns, and explains the relatively high rate of burring in our series, i.e., burring of outer table of the cranium for cases where the deep margin was narrow but where gross/microscopic bone invasion was not present.…”

“…This was an unexpected finding as the association between immunosuppression and worse disease outcomes has been documented in several previous studies including those from our institution, but this was likely due to the low number of patients who were immunosuppressed in our cohort. 7,14,15 Molecular or genetic markers may offer greater accuracy in identifying aggressiveness of disease compared with morphological characteristics (this is beyond the scope of this article, but is an active area of research at our institution). 16 Comparison with Emerging Therapies Surgery and PORT is current standard of care for advanced cSCC, with concurrent chemoradiotherapy being routine for some institutions in cases where there is extranodal extension in regional metastasis.…”

“…Until relatively recently, alternatives to radical surgery for advanced HNcSCC, such as definitive radiotherapy ± chemotherapy (cisplatin and carboplatin), have been much inferior to surgery, and were associated with significant adverse events. [5][6][7][8] In September 2018, the immune checkpoint inhibitor (ICI) cemiplimab was approved in the United States and the European Union for patients with unresectable locally advanced or metastatic cSCC who are not candidates for curative surgery or radiotherapy. Approval was granted based largely on positive results in this patient cohort from the pivotal phase II EMPOWER-CSCC trial.…”