title: Multivariate analysis of potential risk factors for lymph node metastasis in patients with cutaneous squamous cell carcinoma of the head and neck.
abstract: BACKGROUND
  The current knowledge about potential risk factors for lymph node (LN) metastasis in patients with head and neck cutaneous squamous cell carcinoma (HNcSCC) is primarily based on studies that lack adjustment for confounding variables.
  
  
  OBJECTIVE
  We sought to identify independent risk factors for LN metastasis in patients with HNcSCC and to evaluate the impact of LN metastasis on prognosis.
  
  
  METHODS
  Patients with primary HNcSCC were retrospectively included. Potential risk factors were analyzed by univariate and multivariate Cox regression models. Survival was compared using the Kaplan-Meier method.
  
  
  RESULTS
  Three hundred thirty-six patients with 545 primary HNcSCCs were included. The median follow-up period was 43 months (range, 1-176 months). LN metastasis occurred in 55 patients (16.4%). The following independent risk factors of HNcSCC for the development of LN metastasis were identified: location on the ear, tumor diameter >50 mm, moderate and poor differentiation, and tumor thickness >2 mm. There was a significant decline in disease-specific survival and overall survival in patients with LN metastasis compared to patients without LN metastasis.
  
  
  CONCLUSIONS
  The retrospective study design.
  
  
  CONCLUSIONS
  LN metastases from HNcSCC are common with diminished survival rates. This study confirmed some well-known risk factors, but also found moderate differentiation as an independent risk factor for LN metastasis.
authors.affiliation: Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Marjolijn S
authors.initials: MS
authors.lastname: Haisma
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Boudewijn E C
authors.initials: BEC
authors.lastname: Plaat
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Hendrik P
authors.initials: HP
authors.lastname: Bijl
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Jan L N
authors.initials: JLN
authors.lastname: Roodenburg
authors.affiliation: Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Gilles F H
authors.initials: GFH
authors.lastname: Diercks
authors.affiliation: Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Tonnis R
authors.initials: TR
authors.lastname: Romeijn
authors.affiliation: Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: j.b.terra@umcg.nl.
authors.forename: Jorrit B
authors.initials: JB
authors.lastname: Terra
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate
keywords: cutaneous squamous cell carcinoma; head and neck; lymph node metastasis; moderate differentiation; prognosis; risk factors