title: Metastatic cutaneous squamous cell carcinoma of the head and neck: the Immunosuppression, Treatment, Extranodal spread, and Margin status (ITEM) prognostic score to predict outcome and the need to improve survival.
abstract: BACKGROUND
  : The authors propose a prognostic score model using a prospective study of patients with regional metastatic cutaneous squamous cell carcinoma of the head and neck.
  
  
  METHODS
  : Two-hundred fifty patients were analyzed using a competing risks model to identify risk factors for survival. A risk score was obtained using the significant coefficients from the regression model, and cutoff points were determined that separated the score into 3 risk groups (low risk, moderate risk, and high risk).
  
  
  RESULTS
  : At a median follow-up of 54 months (range, 1.3-212 months) 70 of 250 patients (28%) developed recurrent disease: Most were regional recurrences (51 of 70 patients; 73%) in the treated lymph node basin. After regional recurrence, a majority (73%) died of disease. The following 4 variables were associated significantly with survival: immunosuppression (hazard ratio [HR], 3.13; 95% confidence interval [CI], 1.39-7.05), treatment (HR, 0.32; 95% CI, 0.16-0.66), extranodal spread (HR, 9.92; 95% CI, 1.28-77.09), and margin status (HR, 1.85; 95% CI, 1.85-3.369); and those 4 variables (immuosuppression, treatment, extranodal spread, and margin status) were used to calculate the ITEM score. The 5-year risk of dying from disease for patients with high-risk (>3.0), moderate-risk (>2.6-3.0), and low-risk (< or =2.6) ITEM scores were 56%, 24%, and 6%, respectively. Fifty-six of 250 patients (22%) died from another cause.
  
  
  CONCLUSIONS
  : Patients who underwent surgery and received adjuvant radiotherapy had a better outcome compared with patients who underwent surgery alone. Patients who had moderate- or high-risk ITEM scores, usually because of extranodal spread and involved excision margins, had a poor outcome. The authors recommend considering these patients for inclusion in adjuvant chemoradiotherapy trials. Cancer 2009. (c) 2009 American Cancer Society.
authors.affiliation: Head and Neck Cancer Service, Westmead Hospital, University of Sydney, Sydney, Australia.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Oddone
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Morgan
authors.forename: Carsten E
authors.initials: CE
authors.lastname: Palme
authors.forename: Lakmalie
authors.initials: L
authors.lastname: Perera
authors.forename: Jennifer
authors.initials: J
authors.lastname: Shannon
authors.forename: Eva
authors.initials: E
authors.lastname: Wong
authors.forename: Val
authors.initials: V
authors.lastname: Gebski
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Veness
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D007165:Immunosuppression Therapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods*; D012878:Skin Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D016896:Treatment Outcome