Prognostic Factors in Primary Head and Neck Cutaneous Squamous Cell Carcinoma: A Large-Scale, Multi-Institutional Competing-Risks Analysis

IF 1.9 3区医学 Q3 ONCOLOGY

Journal of Surgical Oncology Pub Date : 2026-09-14 Epub Date: 2026-07-12 DOI:10.1002/jso.70325

Fábio Muradás Girardi, Cristian David Cardona Machado, Ashley Wysong, Nina A. Ran, Emily E. Granger, Shlomo A. Koyfman, Allison T. Vidimos, David R. Carr, Kathryn T. Shahwan, Kelsey E. Hirotsu, John A. Carucci, Joi B. Carter, Aaron R. Mangold, Divya Srivastava, David G. Brodland, John A. Zitelli, Tyler J. Willenbrink, Anokhi Jambusaria-Pahlajani, Rajiv I. Nijhawan, Emily S. Ruiz, Javier Cañueto

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引用次数: 0

Abstract

Background

Current staging systems for head and neck cutaneous squamous cell carcinoma (HNCSCC), such as AJCC8 and BWH, often fail to adequately stratify high-risk patients, particularly due to the exclusion of important biological and host factors. This study aimed to identify independent prognostic factors for HNCSCC outcomes in the largest multi-institutional retrospective series to date.

Methods

De-identified data from 8,610 primary HNCSCC tumors, treated with curative intent surgery across multiple international centers, were analyzed. Outcomes included local recurrence (LR), locoregional metastasis (LM), distant metastasis (DM), and disease-specific death (DSD). Multivariable Fine–Gray subdistribution hazard regression models with robust standard errors clustered at the patient level were fitted to generate exploratory hypotheses regarding independent hazard determinants.

Results

During a median follow-up of 31.4 months (IQR 14.2–52.8), the cumulative incidence was 3.3% for LR, 2.7% for LM, 0.5% for DM, and 1.2% for DSD. Multivariable analysis confirmed that tumor diameter, poor differentiation, deep invasion, and large-caliber perineural invasion (LCPNI) were the strongest predictors, being significantly associated with at least three of the four outcomes. Notably, factors currently excluded from or weighted differently in staging systems also proved critical: Immunosuppression was significantly associated with LR (SHR 2.03) and DSD (SHR 1.70); and lymphovascular invasion (LVI) was independently associated with LM (SHR 3.00). Poor differentiation demonstrated high prognostic impact, being a significant predictor for all four endpoints.

Conclusion

Tumor diameter, poor differentiation, deep invasion, LCPNI, immunosuppression status, and LVI are the most critical independent factors for HNCSCC prognosis. Our multi-institutional data provide a robust framework for hypothesis generation, highlighting that incorporating host biological features and non-anatomic variables could significantly refine future staging system discussions.

查看原文本刊更多论文

原发性头颈部皮肤鳞状细胞癌的预后因素：一项大规模、多机构竞争风险分析。

背景：目前头颈部皮肤鳞状细胞癌（HNCSCC）的分期系统，如AJCC8和BWH，往往不能充分地对高危患者进行分层，特别是由于排除了重要的生物学和宿主因素。本研究旨在通过迄今为止最大的多机构回顾性系列研究，确定影响HNCSCC预后的独立预后因素。方法：分析来自多个国际中心的8,610例原发性HNCSCC肿瘤的去识别数据，这些肿瘤接受了治愈性手术治疗。结果包括局部复发（LR）、局部转移（LM）、远处转移（DM）和疾病特异性死亡（DSD）。拟合在患者水平聚集的具有鲁棒标准误差的多变量细灰色亚分布风险回归模型，以产生关于独立危险决定因素的探索性假设。结果：在31.4个月的中位随访期间（IQR为14.2-52.8），LR的累积发病率为3.3%，LM为2.7%，DM为0.5%，DSD为1.2%。多变量分析证实，肿瘤直径、分化差、深部浸润和大口径神经周围浸润（LCPNI）是最强的预测因子，与四种结果中的至少三种结果显著相关。值得注意的是，目前在分期系统中被排除或加权不同的因素也被证明是至关重要的：免疫抑制与LR （SHR 2.03）和DSD （SHR 1.70）显著相关；淋巴血管侵袭（LVI）与LM独立相关（SHR 3.00）。差分化表现出高预后影响，是所有四个终点的重要预测因子。结论：肿瘤直径、分化差、浸润深度、LCPNI、免疫抑制状态、LVI是影响HNCSCC预后最关键的独立因素。我们的多机构数据为假设生成提供了一个强大的框架，强调结合宿主生物学特征和非解剖变量可以显著改善未来分期系统的讨论。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Oncology 医学-外科

CiteScore

4.70

自引率

4.00%

发文量

367

审稿时长

2 months

期刊介绍： The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.