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

Area of Science:

• Oncology
• Dermatology
• Surgical Pathology

Background:

• Current staging systems for head and neck cutaneous squamous cell carcinoma (HNCSCC) inadequately stratify high-risk patients.
• Important biological and host factors are often excluded from existing staging criteria.

Purpose of the Study:

• To identify independent prognostic factors for HNCSCC outcomes.
• To analyze the largest multi-institutional retrospective series of HNCSCC.

Main Methods:

• Analysis of de-identified data from 8,610 primary HNCSCC tumors treated with curative intent surgery.
• Utilized multivariable Fine-Gray subdistribution hazard regression models.
• Examined outcomes including local recurrence, locoregional metastasis, distant metastasis, and disease-specific death.

Main Results:

• Tumor diameter, poor differentiation, deep invasion, and large-caliber perineural invasion (LCPNI) were strong predictors of adverse outcomes.
• Immunosuppression was linked to increased local recurrence and disease-specific death.
• Lymphovascular invasion (LVI) independently predicted locoregional metastasis; poor differentiation impacted all four endpoints.

Conclusions:

• Tumor diameter, poor differentiation, deep invasion, LCPNI, immunosuppression, and LVI are critical independent prognostic factors for HNCSCC.
• Incorporating host biological and non-anatomic variables can significantly refine HNCSCC staging systems.