Survival rates in head and neck cutaneous squamous cell carcinoma with nodal metastases: a multicenter study

The primary objective of this study was to identify potential prognostic factors influencing disease control and survival outcomes in patients with neck metastases (NLM) and/or intraparotid metastases (PLM) arising from cutaneous squamous cell carcinoma (cSCC) of the head and neck. A secondary aim was to compare patients with isolated NLM, isolated PLM, and concurrent NLM/PLM.

An observational, retrospective multicenter study included 68 patients with nodal metastatic cSCC treated at the Head and Neck Units of Bologna, Modena, and Pescara (2014-2024). Clinical, pathological, and treatment variables were analyzed for associations with survival using univariate and multivariate Cox regression models (IBM SPSS).

The cohort included 30 patients with isolated NLM (44%), 14 with isolated PLM (21%), and 24 with both NLM and PLM (35%). At 5 years, DFS was 33.8%, DSS 70.6%, and OS 69.1%. DFS was reduced by extranodal extension (ENE) in PLM (HR 3.95, 95% CI 1.65-9.48, p = .002). DSS was negatively influenced by perineural invasion (HR 4.53, 95% CI 1.02-34.44, p= 0.016), NLM ENE (HR 5.60, 95% CI 1.72-18.19, p = 0.004), and PLM ENE (HR 8.90, 95% CI 2.51-18.90, p < 0.001). OS was independently worsened by PNI (HR 6.16, 95% CI 1.20-31.39, p = 0.029), NLM ENE (HR 5.18, 95% CI 1.67-16.03, p= 0.004), and PLM ENE (HR 7.03, 95% CI 2.24-22.07, p < 0.001). Female sex (36% in isolated PLM vs 3% in isolated NLM, p = .004) and immunosuppression (67% in patients with both NLM and PLM, p = 0.02) were significantly associated with nodal dissemination pattern, but not with survival.

This study highlights the prognostic relevance of PNI, ENE, advanced nodal stage, and lack of adjuvant RT in nodal metastatic cSCC. Immunosuppression and female sex appear more related to higher nodal dissemination patterns than to survival.