A multi-institutional comparison of outcomes of immunosuppressed and immunocompetent patients treated with surgery and radiation therapy for cutaneous squamous cell carcinoma of the head and neck.
Patients who are chronically immunosuppressed have higher rates of cutaneous squamous cell carcinoma of the head and neck (cSCC-HN). This is the largest multi-institutional study to date investigating the effect of immune status on disease outcomes in patients with cSCC-HN who underwent surgery and received postoperative radiation therapy (RT).



Patients from 3 institutions who underwent surgery and also received postoperative RT for primary or recurrent, stage I through IV cSCC-HN between 1995 and 2015 were included in this institutional review board-approved study. Patients categorized as immunosuppressed had chronic hematologic malignancy, human immunodeficiency/acquired immunodeficiency syndrome, or had received immunosuppressive therapy for organ transplantation ≥6 months before diagnosis. Overall survival, locoregional recurrence-free survival, and progression-free survival were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed using Cox proportional-hazards regression.



Of 205 patients, 138 (67.3%) were immunocompetent, and 67 (32.7%) were immunosuppressed. Locoregional recurrence-free survival (47.3% vs 86.1%; P < .0001) and progression-free survival (38.7% vs 71.6%; P = .002) were significantly lower in immunosuppressed patients at 2 years. The 2-year OS rate in immunosuppressed patients demonstrated a similar trend (60.9% vs 78.1%; P = .135) but did not meet significance. On multivariate analysis, immunosuppressed status (hazard ratio [HR], 3.79; P < .0001), recurrent disease (HR, 2.67; P = .001), poor differentiation (HR, 2.08; P = .006), and perineural invasion (HR, 2.05; P = .009) were significantly associated with locoregional recurrence.



Immunosuppressed patients with cSCC-HN had dramatically lower outcomes compared with immunocompetent patients, despite receiving bimodality therapy. Immune status is a strong prognostic factor that should be accounted for in prognostic systems, treatment algorithms, and clinical trial design. Cancer 2017;123:2054-2060. © 2017 American Cancer Society.
Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
Bindu V
BV
Manyam
Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
Adam A
AA
Garsa
Department of Radiation Oncology, Washington University, St. Louis, Missouri.
Re-I
RI
Chin
Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
Chandana A
CA
Reddy
Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio.
Brian
B
Gastman
Department of Radiation Oncology, Washington University, St. Louis, Missouri.
Wade
W
Thorstad
Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
Sue S
SS
Yom
Department of Otolaryngology, Washington University, St. Louis, Missouri.
Brian
B
Nussenbaum
Department of Otolaryngology, University of California San Francisco, San Francisco, California.
Steven J
SJ
Wang
Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.
Allison T
AT
Vidimos
Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
Shlomo A
SA
Koyfman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D062109:Dermatologic Surgical Procedures; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D015658:HIV Infections / Q000276:immunology; D006258:Head and Neck Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007121:Immunocompetence / Q000276:immunology*; D016867:Immunocompromised Host / Q000276:immunology*; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000276:immunology; D008228:Lymphoma, Non-Hodgkin / Q000276:immunology; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D000077195:Squamous Cell Carcinoma of Head and Neck; D066027:Transplant Recipients
D007166:Immunosuppressive Agents
cutaneous squamous cell carcinoma; head and neck; immunosuppression; poor outcomes; postoperative radiation therapy