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Outcomes of cutaneous squamous cell carcinoma of the head and neck with parotid metastases
Author(s) -
McDowell Lachlan J,
Tan TzeJian,
Bressel Mathias,
Estall Vanessa,
Kleid Stephen,
Corry June,
Johnston Meredith L
Publication year - 2016
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/1754-9485.12484
Subject(s) - medicine , hazard ratio , confidence interval , multivariate analysis , lymph node , oncology , radiation therapy , head and neck cancer , proportional hazards model , immunosuppression , gastroenterology , surgery
Cutaneous squamous cell carcinoma of the head and neck ( cHNSCC ) metastatic to the parotid has a moderate risk of recurrence despite multimodality treatment. Immunosuppression is associated with lower rates of long‐term cure. Our aim was to review outcomes of current management in a tertiary centre with a view to targeting future strategies. Methods A retrospective review of clinico‐pathological data and outcomes for patients with metastatic cHNSCC involving the parotid gland, undergoing radical surgery and adjuvant radiotherapy during 2000–2014 was conducted. The Kaplan–Meier method was used to determine time‐to‐event outcomes. Results One hundred and thirty‐two patients met the inclusion criteria. Median follow‐up was 5.0 years. Five‐year overall ( OS ), cancer‐specific ( CSS ) and progression free survival ( PFS ) were 44% (95% Confidence Interval ( CI ) 34–53%), 64% (95% CI 52–74%) and 37% (95% CI 28–47%) respectively. Locoregional control ( LRC ) was 68% (95% CI 55–77%) at 5 years. Immunosuppressed patients fared worse (compared with immune‐competent) with five‐year OS , CSS , and PFS of 14% versus 53% ( HR = 3.19; 95% CI 1.91–5.34), 40% versus 71% (Hazard Ratio ( HR ) = 2.92; 95% CI 1.38–6.19) and 10% versus 46% ( HR = 2.51; 95% CI 1.52–4.14) respectively. On multivariate analysis, immune status strongly predicted OS ( P < 0.001), CSS ( P = 0.003), DMFS ( P < 0.001) and PFS ( P < 0.001), but not LRC . Largest lymph node size was the only significant factor predictive for LRC on multivariate analysis ( P = 0.02). Conclusions Despite multimodality treatment metastatic cHNSCC involving the parotid shows moderate rates of recurrence. Immunosuppressed patients with this disease have a particularly poor prognosis, demonstrating lower rates of CSS with similar rates of LRC compared to their immunocompetent counterparts.