Risk factors for local and nodal recurrence in patients with head and neck cutaneous squamous cell carcinoma in a high-reference oncological center in Poland
Abstract
Background: The behavior of cutaneous squamous cell carcinoma (cSCC) of the head and neck remains poorly understood. There is much controversy regarding the risk of local and nodal recurrences, as well as individual/environmental factors that increase the risk, such as tumor size, perineural invasion, and the state of the immune system.
The objective was to analyze factors influencing local and/or regional lymph node recurrence in patients with cSCC in the head and neck region.
Material and methods: This retrospective single-centre study included 521 patients with cSCC of the head and neck region, with local recurrence observed in 11% and nodal recurrence in 5%. Various potential risk factors were analyzed.
Results: Statistically significant risk factors for both local and nodal recurrence include: tumor recurrence (p < 0.0001, p < 0.0001 respectively), tissue inflammation confirmed histopathologically (p < 0.0001, p = 0.0019, respectively), tumor size ≥ 10 mm (p = 0.018, p = 0.0056, respectively), invasion depth > 2 mm (p = 0.0238, p = 0.0031, respectively). Risk factors significant only for local recurrence include: surgical margins (p = 0.0056), tumor differentiation grade (p = 0.0149). No risk factors were found to be significant solely for nodal recurrence.
Conclusion: The authors argue that, in addition to classically recognized risk factors for local and nodal recurrence, attention should be paid to the presence of tissue inflammation confirmed histopathologically. It is also suggested to consider a tumor size of 10mm as a threshold, increasing the risk of recurrence, instead of the frequently proposed 20 mm.
Keywords: cutaneous squamous cell carcinomalocal recurrencenodal recurrencerisk factors
References
- Rogers HW, Weinstock MA, Feldman SR, et al. Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the U.S. Population, 2012. JAMA Dermatol. 2015; 151(10): 1081–1086.
- Dwojak S, Emerick KS. Sentinel lymph node biopsy for cutaneous head and neck malignancies. Expert Rev Anticancer Ther. 2015; 15(3): 305–315.
- Rajabi-Moghaddam M, Abbaszadeh H. Gene polymorphisms and risk of head and neck squamous cell carcinoma: a systematic review. Rep Pract Oncol Radiother. 2022; 27(6): 1058–1076.
- Kozłowska-Masłoń J, Guglas K, Kolenda T, et al. miRNA in head and neck squamous cell carcinomas: promising but still distant future of personalized oncology. Rep Pract Oncol Radiother. 2023; 28(5): 681–697.
- Schmults CD, Karia PS, Carter JB, et al. Factors predictive of recurrence and death from cutaneous squamous cell carcinoma: a 10-year, single-institution cohort study. JAMA Dermatol. 2013; 149(5): 541–547.
- Levine DE, Karia PS, Schmults CD. Outcomes of Patients With Multiple Cutaneous Squamous Cell Carcinomas: A 10-Year Single-Institution Cohort Study. JAMA Dermatol. 2015; 151(11): 1220–1225.
- McDowell LJ, Tan TJ, Bressel M, et al. Outcomes of cutaneous squamous cell carcinoma of the head and neck with parotid metastases. J Med Imaging Radiat Oncol. 2016; 60(5): 668–676.
- Dean NR, Sweeny L, Magnuson JS, et al. Outcomes of recurrent head and neck cutaneous squamous cell carcinoma. J Skin Cancer. 2011; 2011: 972497.
- Haisma MS, Plaat BEC, Bijl HP, et al. Multivariate analysis of potential risk factors for lymph node metastasis in patients with cutaneous squamous cell carcinoma of the head and neck. J Am Acad Dermatol. 2016; 75(4): 722–730.
- Moore BA, Weber RS, Prieto V, et al. Lymph node metastases from cutaneous squamous cell carcinoma of the head and neck. Laryngoscope. 2005; 115(9): 1561–1567.
- Jambusaria-Pahlajani A, Kanetsky PA, Karia PS, et al. Evaluation of AJCC tumor staging for cutaneous squamous cell carcinoma and a proposed alternative tumor staging system. JAMA Dermatol. 2013; 149(4): 402–410.
- Hirshoren N, Danne J, Dixon BJ, et al. Prognostic markers in metastatic cutaneous squamous cell carcinoma of the head and neck. Head Neck. 2017; 39(4): 772–778.
- Stratigos AJ, Garbe C, Dessinioti C, et al. European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC). European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 1. epidemiology, diagnostics and prevention. Eur J Cancer. 2020; 128: 60–82.
- Zeng S, Fu L, Zhou P, et al. Identifying risk factors for the prognosis of head and neck cutaneous squamous cell carcinoma: A systematic review and meta-analysis. PLoS One. 2020; 15(9): e0239586.
- Thompson AK, Kelley BF, Prokop LJ, et al. Risk Factors for Cutaneous Squamous Cell Carcinoma Recurrence, Metastasis, and Disease-Specific Death: A Systematic Review and Meta-analysis. JAMA Dermatol. 2016; 152(4): 419–428.
- Li K, Zeng X, Liu P, et al. The Role of Inflammation-Associated Factors in Head and Neck Squamous Cell Carcinoma. J Inflamm Res. 2023; 16: 4301–4315.
- Liersch J, von Köckritz A, Schaller J. Dermatopathology 101. Part 2 - Skin tumors. J Dtsch Dermatol Ges. 2017; 15(9): 906–929.
- Lubov J, Labbé M, Sioufi K, et al. Prognostic factors of head and neck cutaneous squamous cell carcinoma: a systematic review. J Otolaryngol Head Neck Surg. 2021; 50(1): 54.
- Harris BN, Bayoumi A, Rao S, et al. Factors Associated with Recurrence and Regional Adenopathy for Head and Neck Cutaneous Squamous Cell Carcinoma. Otolaryngol Head Neck Surg. 2017; 156(5): 863–869.
- Brancaccio G, Briatico G, Pellegrini C, et al. Risk Factors and Diagnosis of Advanced Cutaneous Squamous Cell Carcinoma. Dermatol Pract Concept. 2021; 11(Suppl 2): e2021166S.