title: Relevance of the primary lesion in the prognosis of metastatic cutaneous squamous cell carcinoma.
abstract: BACKGROUND
  It remains unclear how primary tumor factors impact on prognosis in patients with nodal metastasis in head and neck cutaneous squamous cell carcinoma (SCC). The purpose of this study was to assess whether primary tumor characteristics are independent prognostic factors.
  
  
  METHODS
  Patients treated for metastatic cutaneous SCC from 1978 to 2010 were identified (n = 239). A proportional hazards model was used to assess the effect of primary tumor variables.
  
  
  RESULTS
  On multivariable analysis, tumor differentiation (hazard ratio [HR], 0.2; 95% confidence interval [CI], 0.1-0.8; p = .03) was found to be significantly associated with disease-specific survival (DSS), unlike margin status (p = .23), tumor size (p = .21), and thickness (p = .11). Patient, treatment, and nodal factors were confirmed to be important predictors of survival.
  
  
  CONCLUSIONS
  This article suggests that pathological features of the primary lesion bear little importance in the presence of established nodal metastasis, other than tumor differentiation. It validates the grouping of T1-3N1 as stage III under the current American Joint Committee on Cancer (AJCC) TNM staging system.
authors.affiliation: The Sydney Head & Neck Cancer Institute, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, New South Wales, Australia. snchng@xtra.co.nz
authors.forename: Sydney
authors.initials: S
authors.lastname: Ch'ng
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Clark
authors.forename: Markus
authors.initials: M
authors.lastname: Brunner
authors.forename: Carsten E
authors.initials: CE
authors.lastname: Palme
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Morgan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Veness
mesh_terms: D000367:Age Factors; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009517:New South Wales; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome