title: Cutaneous head and neck squamous cell carcinoma with regional metastases: the prognostic importance of soft tissue metastases and extranodal spread.
abstract: BACKGROUND
  Extranodal spread (ENS) is an established adverse prognostic factor in metastatic cutaneous squamous cell carcinoma (cSCC); however, the clinical significance of soft tissue metastases (STM) is unknown. The aim of this study was to evaluate the prognosis of patients with STM from head and neck cSCC, and to compare this with that of node metastases with and without ENS.
  
  
  METHODS
  Patients with cSCC metastatic to the parotid and/or neck treated by primary surgical resection between 1987 and 2007 were included. Metastatic nodes >3 cm in size were an exclusion criterion. A Cox proportional hazard model was used to determine the effect of STM adjusting for other relevant prognostic factors.
  
  
  RESULTS
  The population included 164 patients with a median follow-up of 26 months. There were 8 distant and 37 regional recurrences. There were 22 were cancer-specific deaths, and 29 patients died. STM was a significant predictor of reduced overall (hazard ratio 3.3; 95% confidence interval 1.6-6.4; P = 0.001) and disease-free survival (hazard ratio 2.4; 95% confidence interval 1.4-4.1; P = 0.001) when compared to patients with node disease with or without ENS. After adjusting for covariates, STM and number of involved nodes were significant independent predictors of overall and disease-free survival.
  
  
  CONCLUSIONS
  In metastatic cSCC of the head and neck, the presence of STM is an independent predictor of reduced survival and is associated with a greater adverse effect than ENS alone.
authors.affiliation: Sydney Head and Neck Cancer Institute, Sydney Cancer Center, Royal Prince Alfred and Liverpool Hospitals, Sydney, Australia.
authors.forename: Wendy
authors.initials: W
authors.lastname: Kelder
authors.forename: Ardalan
authors.initials: A
authors.lastname: Ebrahimi
authors.forename: Veronique-Isabelle
authors.initials: VI
authors.lastname: Forest
authors.forename: Kan
authors.initials: K
authors.lastname: Gao
authors.forename: Rajmohan
authors.initials: R
authors.lastname: Murali
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D015996:Survival Rate