Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Head Neck. 2023 May;45(5):1080-1087. doi: 10.1002/hed.27304. Epub 2023 Mar 8.
Understanding the impact of surgical treatment on regionally metastatic cutaneous squamous cell carcinoma (cSCC).
Retrospective series of 145 patients undergoing parotidectomy and neck dissection for regionally metastatic cSCC to the parotid. Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) analyzed over 3 years. Multivariate analysis was completed using Cox proportional hazard models.
OS was 74.5%, DSS was 85.5% and DFS was 64.8%. On multivariate analysis, immune status (HR = 3.225[OS], 5.119[DSS], 2.071[DFS]) and lymphovascular invasion (HR = 2.380[OS], 5.237[DSS], 2.595[DFS]) were predictive for OS, DSS, and DFS. Margin status (HR = 2.296[OS], 2.499[DSS]) and ≥18 resected nodes (HR = 0.242[OS], 0.255[DSS]) were predictive of OS and DSS, while adjuvant therapy was predictive of DSS (p = 0.018).
Immunosuppression and lymphovascular invasion portended worse outcomes in patients with metastatic cSCC to the parotid. Microscopically positive margins and <18 nodes resected are associated with worse OS and DSS, while patients receiving adjuvant therapy had improved DSS.
了解手术治疗对局部转移性皮肤鳞状细胞癌（cSCC）的影响。
回顾性分析了 145 例因腮腺局部转移性 cSCC 而行腮腺切除术和颈部淋巴结清扫术的患者。分析了 3 年以上的总生存率（OS）、疾病特异性生存率（DSS）和无病生存率（DFS）。使用 Cox 比例风险模型进行多变量分析。
OS 为 74.5%，DSS 为 85.5%，DFS 为 64.8%。多变量分析显示，免疫状态（HR=3.225[OS]、5.119[DSS]、2.071[DFS]）和淋巴血管侵犯（HR=2.380[OS]、5.237[DSS]、2.595[DFS]）是 OS、DSS 和 DFS 的预测因素。切缘状态（HR=2.296[OS]、2.499[DSS]）和≥18 个切除的淋巴结（HR=0.242[OS]、0.255[DSS]）是 OS 和 DSS 的预测因素，而辅助治疗是 DSS 的预测因素（p=0.018）。
免疫抑制和淋巴血管侵犯预示着转移性腮腺 cSCC 患者的预后较差。显微镜下阳性切缘和切除的淋巴结<18 个与 OS 和 DSS 较差相关，而接受辅助治疗的患者 DSS 改善。
