title: Inferior outcomes in immunosuppressed patients with high-risk cutaneous squamous cell carcinoma of the head and neck treated with surgery and radiation therapy.
abstract: BACKGROUND
  Immunosuppressed patients have higher rates of cutaneous squamous cell carcinoma of the head and neck.
  
  
  OBJECTIVE
  This study reviews the effect of immune status on disease characteristics and treatment outcomes.
  
  
  METHODS
  Patients with cutaneous squamous cell carcinoma of the head and neck treated with surgery and postoperative radiotherapy between 2000 and 2011 were included. Immunosuppressed patients underwent prior organ transplantation or chemotherapy. Baseline variables were compared using χ(2) and unpaired t tests. Overall survival and disease-free survival were calculated using the Kaplan-Meier method.
  
  
  RESULTS
  In this study of 59 patients, 38 (64%) were immunocompetent and 21 (36%) were immunosuppressed. Most patients had recurrent tumors (63%) and node-positive disease (61%), which were well balanced between the groups. Poorly differentiated tumors (62% vs 21%; P = .009), lymphovascular invasion (29% vs 11%; P = .08), and extracapsular extension (57% vs 41%; P = .09) were more frequent in the immunosuppressed group. Two-year disease-free survival (45% vs 62%) and 2-year overall survival (36% vs 67%) were inferior for immunosuppressed patients.
  
  
  CONCLUSIONS
  Limitations include single institution, retrospective study with small sample size, and potential referral bias.
  
  
  CONCLUSIONS
  Immunosuppressed patients with cutaneous squamous cell carcinoma of the head and neck more frequently present with high-risk pathologic features and inferior outcomes. Early multidisciplinary assessment and alternate management strategies merit prospective investigation.
authors.affiliation: Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Bindu V
authors.initials: BV
authors.lastname: Manyam
authors.affiliation: Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Brian
authors.initials: B
authors.lastname: Gastman
authors.affiliation: Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Alexandra Y
authors.initials: AY
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Chandana A
authors.initials: CA
authors.lastname: Reddy
authors.affiliation: Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Brian B
authors.initials: BB
authors.lastname: Burkey
authors.affiliation: Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Joseph
authors.initials: J
authors.lastname: Scharpf
authors.affiliation: Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Alam
authors.affiliation: Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Fritz
authors.affiliation: Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Allison T
authors.initials: AT
authors.lastname: Vidimos
authors.affiliation: Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio. Electronic address: koyfmas@ccf.org.
authors.forename: Shlomo A
authors.initials: SA
authors.lastname: Koyfman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D062109:Dermatologic Surgical Procedures / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007121:Immunocompetence / Q000276:immunology; D016867:Immunocompromised Host / Q000276:immunology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
keywords: cutaneous squamous cell carcinoma; head and neck; high-risk skin cancer; immunosuppressed; radiation; transplantation