Ardalan Ebrahimi, Ruta Gupta, Lachlan McDowell, Matthew J R Magarey, Paul N Smith, Klaus-Martin Schulte, Diana M Perriman, Michael Veness, Sandro Porceddu, Tsu-Hui Hubert Low, Allan Fowler, Jonathan R Clark
{"title":"Determinants of Prognosis in Head and Neck Cutaneous Squamous Cell Carcinoma With Nodal Metastases.","authors":"Ardalan Ebrahimi, Ruta Gupta, Lachlan McDowell, Matthew J R Magarey, Paul N Smith, Klaus-Martin Schulte, Diana M Perriman, Michael Veness, Sandro Porceddu, Tsu-Hui Hubert Low, Allan Fowler, Jonathan R Clark","doi":"10.1001/jamaoto.2024.3103","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>The eighth edition tumor, node, metastasis (TNM) staging for head and neck cutaneous squamous cell carcinoma (HNcSCC) is a poor predictor of survival in patients with lymph node metastases, possibly due to the inclusion of extranodal extension (ENE).</p><p><strong>Objective: </strong>To identify the key determinants of prognosis in patients with nodal metastatic HNcSCC and analyze the association of ENE with TNM stage and investigate for prognostic heterogeneity in ENE-positive disease.</p><p><strong>Design, setting, and participants: </strong>This retrospective, multicenter cohort study was conducted at 4 Australian tertiary referral centers using prospectively collected data in patients treated between 1980 and 2017 with a median (IQR) follow-up of 3.2 (3.9) years. The study population included 1309 consecutive patients with HNcSCC that was metastatic to parotid and/or cervical nodes. After excluding cases with perioperative mortality, missing data, or follow-up, the final study population included 1151 patients.</p><p><strong>Exposure: </strong>Curative intent surgery ± adjuvant radiotherapy.</p><p><strong>Main outcomes and measures: </strong>Differences in locoregional control (LRC), disease-specific survival (DSS), and overall survival were determined using Cox regression analysis.</p><p><strong>Results: </strong>Among 1151 patients, 976 (84.8%) were male and 175 (15.2%) female, with a median age of 73.3 years (range, 18-100 years). On multivariable analysis, immunosuppression (hazard ratio [HR], 2.48; 95% CI, 1.64-3.74), perineural invasion (HR, 1.69; 95% CI, 1.25-2.30), ENE (HR, 1.53; 95% CI, 0.95-2.44), size (>3-6 cm vs ≤3 cm [HR, 1.41; 95% CI, 1.03-1.93]; >6 cm vs ≤3 cm [HR, 5.01; 95% CI, 2.98-8.42]), and number of nodal metastases (3-4 vs 1-2 [HR, 1.54; 95% CI, 1.01-2.34]; ≥5 vs 1-2 [HR, 2.86; 95% CI, 1.99-4.11]) were associated with DSS. Similar results were found for LRC and overall survival. More than 90% of the population was categorized as TNM stage IV, with 32% attributable to ENE. In the ENE-positive subset (n = 860), DSS ranged from 8% to 88% based on stratification using other clinicopathological factors.</p><p><strong>Conclusions and relevance: </strong>The study results suggest that immunosuppression, perineural invasion, ENE, and size and number of nodal metastases are associated with reduced survival and LRC in HNcSCC with nodal metastases. The inclusion of ENE in HNcSCC staging needs to be reassessed, as it ascribes excessive importance to ENE and upstages most patients to TNM stage IV, despite many having a high chance of cure.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"986-994"},"PeriodicalIF":6.0000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11428024/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA otolaryngology-- head & neck surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1001/jamaoto.2024.3103","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Importance: The eighth edition tumor, node, metastasis (TNM) staging for head and neck cutaneous squamous cell carcinoma (HNcSCC) is a poor predictor of survival in patients with lymph node metastases, possibly due to the inclusion of extranodal extension (ENE).
Objective: To identify the key determinants of prognosis in patients with nodal metastatic HNcSCC and analyze the association of ENE with TNM stage and investigate for prognostic heterogeneity in ENE-positive disease.
Design, setting, and participants: This retrospective, multicenter cohort study was conducted at 4 Australian tertiary referral centers using prospectively collected data in patients treated between 1980 and 2017 with a median (IQR) follow-up of 3.2 (3.9) years. The study population included 1309 consecutive patients with HNcSCC that was metastatic to parotid and/or cervical nodes. After excluding cases with perioperative mortality, missing data, or follow-up, the final study population included 1151 patients.
Exposure: Curative intent surgery ± adjuvant radiotherapy.
Main outcomes and measures: Differences in locoregional control (LRC), disease-specific survival (DSS), and overall survival were determined using Cox regression analysis.
Results: Among 1151 patients, 976 (84.8%) were male and 175 (15.2%) female, with a median age of 73.3 years (range, 18-100 years). On multivariable analysis, immunosuppression (hazard ratio [HR], 2.48; 95% CI, 1.64-3.74), perineural invasion (HR, 1.69; 95% CI, 1.25-2.30), ENE (HR, 1.53; 95% CI, 0.95-2.44), size (>3-6 cm vs ≤3 cm [HR, 1.41; 95% CI, 1.03-1.93]; >6 cm vs ≤3 cm [HR, 5.01; 95% CI, 2.98-8.42]), and number of nodal metastases (3-4 vs 1-2 [HR, 1.54; 95% CI, 1.01-2.34]; ≥5 vs 1-2 [HR, 2.86; 95% CI, 1.99-4.11]) were associated with DSS. Similar results were found for LRC and overall survival. More than 90% of the population was categorized as TNM stage IV, with 32% attributable to ENE. In the ENE-positive subset (n = 860), DSS ranged from 8% to 88% based on stratification using other clinicopathological factors.
Conclusions and relevance: The study results suggest that immunosuppression, perineural invasion, ENE, and size and number of nodal metastases are associated with reduced survival and LRC in HNcSCC with nodal metastases. The inclusion of ENE in HNcSCC staging needs to be reassessed, as it ascribes excessive importance to ENE and upstages most patients to TNM stage IV, despite many having a high chance of cure.
重要性：第八版头颈部皮肤鳞状细胞癌（HNcSCC）的肿瘤、结节、转移（TNM）分期对淋巴结转移患者的生存预测较差，这可能是由于纳入了结节外扩展（ENE）：目的：确定结节转移性HNcSCC患者预后的关键决定因素，分析ENE与TNM分期的关系，并研究ENE阳性疾病的预后异质性：这项回顾性多中心队列研究在澳大利亚的 4 家三级转诊中心进行，使用了前瞻性收集的 1980 年至 2017 年期间接受治疗的患者数据，中位（IQR）随访时间为 3.2（3.9）年。研究对象包括1309名转移至腮腺和/或颈部结节的HNcSCC连续患者。在排除围手术期死亡、数据缺失或随访的病例后，最终的研究对象包括1151名患者：主要结果和测量指标：局部区域疗效的差异：采用Cox回归分析法确定局部控制（LRC）、疾病特异性生存（DSS）和总生存率的差异：在1151名患者中，男性976人（84.8%），女性175人（15.2%），中位年龄为73.3岁（18-100岁）。在多变量分析中，免疫抑制（危险比 [HR]，2.48；95% CI，1.64-3.74）、神经周围侵犯（HR，1.69；95% CI，1.25-2.30）、ENE（HR，1.53；95% CI，0.95-2.44）、大小（>3-6 cm vs ≤3 cm [HR，1.41；95% CI，1.03-1.93]；>6 cm vs ≤3 cm [HR，5.01；95% CI，2.98-8.42]）和结节转移数量（3-4 vs 1-2 [HR，1.54；95% CI，1.01-2.34]；≥5 vs 1-2 [HR，2.86；95% CI，1.99-4.11]）与 DSS 相关。LRC 和总生存率也有类似的结果。在ENE阳性亚组（n = 860）中，根据其他临床病理学因素进行分层，DSS从8%到88%不等：研究结果表明，免疫抑制、神经周围侵犯、ENE、结节转移灶的大小和数量与伴有结节转移的HNcSCC生存率和LRC降低有关。需要重新评估将ENE纳入HNcSCC分期的做法，因为它过分重视ENE，并将大多数患者的分期上调至TNM IV期，尽管许多患者有很大的治愈机会。
期刊介绍：
JAMA Otolaryngology–Head & Neck Surgery is a globally recognized and peer-reviewed medical journal dedicated to providing up-to-date information on diseases affecting the head and neck. It originated in 1925 as Archives of Otolaryngology and currently serves as the official publication for the American Head and Neck Society. As part of the prestigious JAMA Network, a collection of reputable general medical and specialty publications, it ensures the highest standards of research and expertise. Physicians and scientists worldwide rely on JAMA Otolaryngology–Head & Neck Surgery for invaluable insights in this specialized field.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
