Immunocompromised patients with metastatic cutaneous nodal squamous cell carcinoma of the head and neck: Poor outcome unrelated to the index lesion

Johnson K S Lam; Puma Sundaresan; Val Gebski; Michael J Veness

doi:10.1002/hed.25069

Immunocompromised patients with metastatic cutaneous nodal squamous cell carcinoma of the head and neck: Poor outcome unrelated to the index lesion

Head Neck. 2018 May;40(5):985-992. doi: 10.1002/hed.25069. Epub 2018 Jan 23.

Authors

Johnson K S Lam^{1

2}, Puma Sundaresan^{1

3}, Val Gebski^{1

4}, Michael J Veness^{1

3}

Affiliations

¹ Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia.
² Department of Radiation Oncology, Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia.
³ Sydney Medical School, University of Sydney, Sydney, Australia.
⁴ National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, Australia.

PMID: 29360262
DOI: 10.1002/hed.25069

Abstract

Background: Immunocompromised patients with metastatic cutaneous nodal head and neck squamous cell carcinoma (HNSCC) have worse outcomes compared to the immunocompetent. The purpose of this study was to investigate the characteristics of the primary cutaneous squamous cell carcinoma (SCC), nodal pathology, and outcome between these 2 groups.

Methods: Analysis of a prospective database was performed. A 2:1 pooled analysis selected 46 immunocompetent patients matched with 23 immunocompromised patients. Overall survival (OS) and relapse-free survival (RFS) were calculated using the Kaplan-Meier method.

Results: No significant difference was found in the primary tumor characteristics between the 2 groups. In the immunocompromised group, RFS (hazard ratio [HR] 2.70; P = .01) and OS (HR 2.32; P = .04) were significantly worse. Extracapsular spread was present in 100% of the immunocompromised patients.

Conclusion: No significant difference was identified in the primary cutaneous SCC between the immunocompetent and immunocompromised patients. Immunosuppression predicted worse outcome.

Keywords: cutaneous squamous cell carcinoma; head and neck; immunocompromised; metastatic; nodal metastases.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Carcinoma, Squamous Cell / immunology
Carcinoma, Squamous Cell / mortality
Carcinoma, Squamous Cell / secondary*
Case-Control Studies
Disease-Free Survival
Female
Head and Neck Neoplasms / immunology
Head and Neck Neoplasms / mortality
Head and Neck Neoplasms / secondary*
Humans
Immunocompromised Host*
Male
Middle Aged
Skin Neoplasms / immunology
Skin Neoplasms / mortality
Skin Neoplasms / pathology*
Survival Rate
Young Adult