Predictors of distant metastatic recurrence in head and neck cutaneous squamous cell carcinoma with lymph node metastases treated with curative intent: A multicenter study

Ardalan Ebrahimi; Ruta Gupta; Lachlan McDowell; Matthew J.R. Magarey; Paul N. Smith; Klaus-Martin Schulte; Diana M. Perriman; Michael Veness; Sandro Porceddu; Tsu Hui Hubert Low; Allan Fowler; Jonathan R. Clark

doi:10.1002/hed.27912

Predictors of distant metastatic recurrence in head and neck cutaneous squamous cell carcinoma with lymph node metastases treated with curative intent: A multicenter study

Ardalan Ebrahimi^*, Ruta Gupta, Lachlan McDowell, Matthew J.R. Magarey, Paul N. Smith, Klaus-Martin Schulte, Diana M. Perriman, Michael Veness, Sandro Porceddu, Tsu Hui Hubert Low, Allan Fowler, Jonathan R. Clark

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: We aimed to identify predictors of distant metastatic recurrence (DMR) in patients with head and neck cutaneous squamous cell carcinoma (HNcSCC) with nodal metastases treated with curative intent.

Methods: Predictors of DMR were identified using Cox regression in a multicenter study of 1151 patients.

Results: The 5-year risk of DMR was 9.6%. On multivariate analysis, immunosuppression (HR 2.93; 95% CI: 1.70–5.05; p < 0.001), nodal size >6 cm [versus ≤3 cm (HR 2.77; 95% CI: 1.09–7.03; p = 0.032)], ≥5 nodal metastases [versus 1–2 (HR 2.79; 95% CI: 1.63–4.78; p < 0.001)], and bilateral disease (HR 3.11; 95% CI: 1.40–6.90; p = 0.005) predicted DMR. A DMR risk score was developed that stratified risk from 6.6% (no risk factors) to 100% (≥3 risk factors) (p < 0.001).

Conclusions: The risk of DMR in nodal metastatic HNcSCC increases with immunosuppression, nodal size >6 cm, ≥5 nodal metastases, and bilateral disease. A simple DMR risk score estimated prior to treatment may be clinically useful.

Original language	English
Pages (from-to)	254-262
Number of pages	9
Journal	Head and Neck
Volume	47
Issue number	1
Early online date	9 Aug 2024
DOIs	https://doi.org/10.1002/hed.27912
Publication status	Published - Jan 2025

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Ebrahimi, A., Gupta, R., McDowell, L., Magarey, M. J. R., Smith, P. N., Schulte, K.-M., Perriman, D. M., Veness, M., Porceddu, S., Low, T. H. H., Fowler, A., & Clark, J. R. (2025). Predictors of distant metastatic recurrence in head and neck cutaneous squamous cell carcinoma with lymph node metastases treated with curative intent: A multicenter study. Head and Neck, 47(1), 254-262. https://doi.org/10.1002/hed.27912

@article{9e8be54cef1e48a282a552b22df40de3,

title = "Predictors of distant metastatic recurrence in head and neck cutaneous squamous cell carcinoma with lymph node metastases treated with curative intent: A multicenter study",

abstract = "Background: We aimed to identify predictors of distant metastatic recurrence (DMR) in patients with head and neck cutaneous squamous cell carcinoma (HNcSCC) with nodal metastases treated with curative intent. Methods: Predictors of DMR were identified using Cox regression in a multicenter study of 1151 patients. Results: The 5-year risk of DMR was 9.6\%. On multivariate analysis, immunosuppression (HR 2.93; 95\% CI: 1.70–5.05; p < 0.001), nodal size >6 cm [versus ≤3 cm (HR 2.77; 95\% CI: 1.09–7.03; p = 0.032)], ≥5 nodal metastases [versus 1–2 (HR 2.79; 95\% CI: 1.63–4.78; p < 0.001)], and bilateral disease (HR 3.11; 95\% CI: 1.40–6.90; p = 0.005) predicted DMR. A DMR risk score was developed that stratified risk from 6.6\% (no risk factors) to 100\% (≥3 risk factors) (p < 0.001). Conclusions: The risk of DMR in nodal metastatic HNcSCC increases with immunosuppression, nodal size >6 cm, ≥5 nodal metastases, and bilateral disease. A simple DMR risk score estimated prior to treatment may be clinically useful.",

keywords = "cutaneous squamous cell carcinoma, distant metastases, head and neck cancer, lymph node metastasis, prognosis",

author = "Ardalan Ebrahimi and Ruta Gupta and Lachlan McDowell and Magarey, \{Matthew J.R.\} and Smith, \{Paul N.\} and Klaus-Martin Schulte and Perriman, \{Diana M.\} and Michael Veness and Sandro Porceddu and Low, \{Tsu Hui Hubert\} and Allan Fowler and Clark, \{Jonathan R.\}",

note = "{\textcopyright} 2024 The Author(s). Head \& Neck published by Wiley Periodicals LLC.",

year = "2025",

month = jan,

doi = "10.1002/hed.27912",

language = "English",

volume = "47",

pages = "254--262",

journal = "Head and Neck",

issn = "1043-3074",

publisher = "John Wiley \& Sons Inc.",

number = "1",

}

Ebrahimi, A, Gupta, R, McDowell, L, Magarey, MJR, Smith, PN, Schulte, K-M, Perriman, DM, Veness, M, Porceddu, S, Low, THH, Fowler, A & Clark, JR 2025, 'Predictors of distant metastatic recurrence in head and neck cutaneous squamous cell carcinoma with lymph node metastases treated with curative intent: A multicenter study', Head and Neck, vol. 47, no. 1, pp. 254-262. https://doi.org/10.1002/hed.27912

TY - JOUR

T1 - Predictors of distant metastatic recurrence in head and neck cutaneous squamous cell carcinoma with lymph node metastases treated with curative intent

T2 - A multicenter study

AU - Ebrahimi, Ardalan

AU - Gupta, Ruta

AU - McDowell, Lachlan

AU - Magarey, Matthew J.R.

AU - Smith, Paul N.

AU - Schulte, Klaus-Martin

AU - Perriman, Diana M.

AU - Veness, Michael

AU - Porceddu, Sandro

AU - Low, Tsu Hui Hubert

AU - Fowler, Allan

AU - Clark, Jonathan R.

PY - 2025/1

Y1 - 2025/1

N2 - Background: We aimed to identify predictors of distant metastatic recurrence (DMR) in patients with head and neck cutaneous squamous cell carcinoma (HNcSCC) with nodal metastases treated with curative intent. Methods: Predictors of DMR were identified using Cox regression in a multicenter study of 1151 patients. Results: The 5-year risk of DMR was 9.6%. On multivariate analysis, immunosuppression (HR 2.93; 95% CI: 1.70–5.05; p < 0.001), nodal size >6 cm [versus ≤3 cm (HR 2.77; 95% CI: 1.09–7.03; p = 0.032)], ≥5 nodal metastases [versus 1–2 (HR 2.79; 95% CI: 1.63–4.78; p < 0.001)], and bilateral disease (HR 3.11; 95% CI: 1.40–6.90; p = 0.005) predicted DMR. A DMR risk score was developed that stratified risk from 6.6% (no risk factors) to 100% (≥3 risk factors) (p < 0.001). Conclusions: The risk of DMR in nodal metastatic HNcSCC increases with immunosuppression, nodal size >6 cm, ≥5 nodal metastases, and bilateral disease. A simple DMR risk score estimated prior to treatment may be clinically useful.

AB - Background: We aimed to identify predictors of distant metastatic recurrence (DMR) in patients with head and neck cutaneous squamous cell carcinoma (HNcSCC) with nodal metastases treated with curative intent. Methods: Predictors of DMR were identified using Cox regression in a multicenter study of 1151 patients. Results: The 5-year risk of DMR was 9.6%. On multivariate analysis, immunosuppression (HR 2.93; 95% CI: 1.70–5.05; p < 0.001), nodal size >6 cm [versus ≤3 cm (HR 2.77; 95% CI: 1.09–7.03; p = 0.032)], ≥5 nodal metastases [versus 1–2 (HR 2.79; 95% CI: 1.63–4.78; p < 0.001)], and bilateral disease (HR 3.11; 95% CI: 1.40–6.90; p = 0.005) predicted DMR. A DMR risk score was developed that stratified risk from 6.6% (no risk factors) to 100% (≥3 risk factors) (p < 0.001). Conclusions: The risk of DMR in nodal metastatic HNcSCC increases with immunosuppression, nodal size >6 cm, ≥5 nodal metastases, and bilateral disease. A simple DMR risk score estimated prior to treatment may be clinically useful.

KW - cutaneous squamous cell carcinoma

KW - distant metastases

KW - head and neck cancer

KW - lymph node metastasis

KW - prognosis

UR - http://www.scopus.com/inward/record.url?scp=85200987869&partnerID=8YFLogxK

U2 - 10.1002/hed.27912

DO - 10.1002/hed.27912

M3 - Article

AN - SCOPUS:85200987869

SN - 1043-3074

VL - 47

SP - 254

EP - 262

JO - Head and Neck

JF - Head and Neck

IS - 1

ER -

Predictors of distant metastatic recurrence in head and neck cutaneous squamous cell carcinoma with lymph node metastases treated with curative intent: A multicenter study

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