Andruchow Jennifer L, Veness Michael J, Morgan Gary J, Gao Kan, Clifford Anthony, Shannon Kerwin F, Poulsen Michael, Kenny Lizbeth, Palme Carsten E, Gullane Patrick, Morris Christopher, Mendenhall William M, Patel Kepal N, Shah Jatin P, O'Brien Christopher J
Sydney Head and Neck Cancer Institute, Sydney Cancer Centre, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia.
Cancer. 2006 Mar 1;106(5):1078-83. doi: 10.1002/cncr.21698.
Cutaneous squamous cell carcinoma (SCC) of the head and neck is a common cancer that has the potential to metastasize to lymph nodes in the parotid gland and neck. Previous studies have highlighted limitations with the current TNM staging system for metastatic skin carcinoma. The aim of this study was to test a new staging system that may provide better discrimination between patient groups.
A retrospective multicenter study was conducted on 322 patients from three Australian and three North American institutions. All had metastatic cutaneous SCC involving the parotid gland and/or neck and all were treated for cure with a minimum followup time of 2 years. These patients were restaged using a newly proposed system that separated parotid disease (P stage) from neck disease (N stage) and included subgroups of P and N stage. Metastases involved the parotid in 260 patients (149 P1; 78 P2; 33 P3) and 43 of these had clinical neck disease also (22 N1; 21 N2). Neck metastases alone occurred in 62 patients (26 N1; 36 N2). Ninety percent of patients were treated surgically and 267 of 322 received radiotherapy.
Neck nodes were pathologically involved in 32% of patients with parotid metastases. Disease recurred in 105 (33%) of the 322 patients, involving the parotid in 42, neck in 33, and distant sites in 30. Parotid recurrence did not vary significantly with P stage. Disease-specific survival was 74% at 5 years. Survival was significantly worse for patients with advanced P stage: 69% survival at 5 years compared with 82% for those with early P stage (P = 0.02) and for those with both parotid and neck node involvement pathologically: 61% survival compared with 79% for those with parotid disease alone (P = 0.027). Both univariate and multivariate analysis confirmed these findings. Clinical neck involvement among patients with parotid metastases did not significantly worsen survival (P = 0.1).
This study, which included a mixed cohort of patients from six different institutions, provides further information about the clinical behavior of metastatic cutaneous SCC of the head and neck. The hypothesis that separation of parotid and neck disease in a new staging system is supported by the results. The benefit of having subgroups of P and N stage is uncertain, but it is likely to identify patients with unfavorable characteristics that may benefit from further research.
头颈部皮肤鳞状细胞癌（SCC）是一种常见癌症，有转移至腮腺和颈部淋巴结的可能。既往研究强调了当前转移性皮肤癌TNM分期系统存在的局限性。本研究的目的是测试一种新的分期系统，该系统可能在不同患者组间提供更好的区分度。
对来自澳大利亚三个机构和北美三个机构的322例患者进行了一项回顾性多中心研究。所有患者均患有累及腮腺和/或颈部的转移性皮肤SCC，且均接受了根治性治疗，最短随访时间为2年。使用新提出的系统对这些患者重新分期，该系统将腮腺将腮腺疾病（P期）与颈部疾病（N期）分开，并包括P期和N期的亚组。260例患者发生腮腺转移（149例P1；78例P2；33例P3），其中43例同时伴有临床颈部疾病（22例N1；21例N2）。仅发生颈部转移的患者有62例（26例N1；36例N2）。90%的患者接受了手术治疗，322例中有267例接受了放疗。
在有腮腺转移的患者中，32%的患者颈部淋巴结有病理累及。322例患者中有105例（33%）疾病复发，其中42例累及腮腺，33例累及颈部，30例累及远处部位。腮腺复发率在不同P期之间无显著差异。5年疾病特异性生存率为74%。P期晚期患者的生存率明显较差：5年生存率为69%，而早期P期患者为82%（P = 0.02）；病理上同时有腮腺和颈部淋巴结累及的患者生存率为61%，而仅患有腮腺疾病的患者为79%（P = 0.027）。单因素和多因素分析均证实了这些发现。腮腺转移患者中的临床颈部累及情况并未显著降低生存率（P = 0.1）。
本研究纳入了来自六个不同机构的混合患者队列，提供了关于头颈部转移性皮肤SCC临床行为的更多信息。新分期系统中腮腺和颈部疾病分开的假设得到了结果的支持。P期和N期亚组的益处尚不确定，但可能会识别出具有不良特征的患者，这些患者可能会从进一步研究中获益。
