title: Parotid metastatic disease from cutaneous squamous cell carcinoma: prognostic role of facial nerve sacrifice, lateral temporal bone resection, immune status and P-stage.
abstract: BACKGROUND
  Recognized prognostic indicators for metastatic cutaneous squamous cell carcinoma (SCC) of the head and neck include facial nerve involvement, immune status, and "parotid" staging system (P-stage). We sought to examine the impact of lateral temporal bone resection (LTBR) on prognosis.
  
  
  METHODS
  We conducted a retrospective analysis of 160 patients with metastatic cutaneous SCC to the parotid. All patients had parotidectomy and neck dissection; 27% had additional LTBR when the tumor was adherent to the temporal bone.
  
  
  RESULTS
  Overall 5-year survival was 48%, disease-specific survival 77%, and locoregional control 83%. Corresponding results for immunocompetent versus immunocompromised were 55%, 86%, and 87% versus 12%, 48%, and 64%. On Cox regression analysis, only immunocompromised status (ie, lymphoproliferative disorder, organ-transplant patient) was prognostically significant (p < .001).
  
  
  CONCLUSIONS
  More radical resection that may include LTBR mitigates the poorer prognosis with advanced disease in our series. Treatment must be individualized in immunocompromised patients who have shortened overall survival.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Angus
authors.initials: A
authors.lastname: Shao
authors.forename: Danny K C
authors.initials: DK
authors.lastname: Wong
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: McIvor
authors.forename: Alex M
authors.initials: AM
authors.lastname: Mylnarek
authors.forename: John M
authors.initials: JM
authors.lastname: Chaplin
authors.forename: Mark E
authors.initials: ME
authors.lastname: Izzard
authors.forename: Rajan S
authors.initials: RS
authors.lastname: Patel
authors.forename: Randall P
authors.initials: RP
authors.lastname: Morton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D004210:Dissection; D005154:Facial Nerve / Q000601:surgery; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D053208:Kaplan-Meier Estimate; D008297:Male; D037981:Neck Dissection; D010306:Parotid Gland / Q000601:surgery; D010307:Parotid Neoplasms / Q000401:mortality* / Q000556:secondary / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*; D013701:Temporal Bone / Q000601:surgery
keywords: P-stage; cutaneous squamous cell carcinoma; immunocompromise; lateral temporal bone resection; parotid