Predictive factors for long-term survival in head and neck squamous cell carcinoma patients with distant metastasis after initial definitive treatment.
OBJECTIVE
Distant metastasis (DM) of head and neck squamous cell carcinoma (HNSCC) is not common but remains a substantial problem. Here, we evaluated factors predictive of long-term survival in HNSCC patients presenting with DM after initial definitive treatment.


METHODS
The medical records of patients with HNSCC who underwent definitive treatment between 2006 and 2011 were reviewed. Univariate and multivariate analyses were performed to identify clinicopathological factors associated with long-term survival after DM.


RESULTS
Of 779 HNSCC patients, 98 (12.6 %) had DM after completion of definitive treatment, with a median time to DM of 15 months (range 1-87 months). Overall survival (OS) rates at 1 and 2 years after DM were 43.1 and 20.5 %, respectively. In multivariate analysis, hypoalbuminemia (P < 0.001, hazard ratio [HR] 3.45, 95 % confidence interval [CI] 2.01-5.92), prior or simultaneous locoregional failure events (P < 0.001, HR 2.36, 95 % CI 1.47-3.79), multisite DM (P = 0.001, HR 2.30, 95 % CI 1.42-3.72), and no salvage treatment for DM (P = 0.003, HR 2.19, 95 % CI 1.32-3.64) were independent predictors of OS after the development of DM. Seventeen (18 %) patients survived >2 years. Patients who did not have any of these risk factors had the most favorable outcomes, with a 2-year survival of 100 %.


CONCLUSIONS
In the absence of risk factors, long-term survival can be achieved despite the development of DM after definitive treatment.
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
Ho-Seob
HS
Kang
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea. rohjl@amc.seoul.kr.
Jong-Lyel
JL
Roh
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
Min-Ju
MJ
Kim
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
Kyung-Ja
KJ
Cho
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
Sang-wook
SW
Lee
Department of Internal Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
Sung-Bae
SB
Kim
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
Seung-Ho
SH
Choi
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
Soon Yuhl
SY
Nam
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
Sang Yoon
SY
Kim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D003131:Combined Modality 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; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
Distant metastasis; Head and neck; Long-term survival; Risk factors; Squamous cell carcinoma