Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Zdravotniku 248/7, Olomouc 77900, Czech Republic.
Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University, Hnevotinska 3 77515, Olomouc, Czech Republic.
Int J Clin Pract. 2024 Feb 19;2024:5525741. doi: 10.1155/2024/5525741. eCollection 2024.
Cutaneous squamous cell carcinomas (cSCC) are malignant tumours with excellent prognosis unless nodal metastases develop. The aim of our study is to determine the prognostic significance of the clinical stage of parotid gland metastases and the incidence of occult cervical lymph node involvement in cSCC of the head. Our retrospective analysis includes 39 patients with cSCC parotid gland metastases, 15 of whom had concurrent cervical node involvement. In 32 patients, the lymph nodes manifested at stage N3b. A total of 26 patients were treated with parotidectomy, 9 patients received radiotherapy alone, and 4 received symptomatic therapy. The surgical treatment included either total conservative (21 cases) or superficial parotidectomy (5 cases) and neck dissection (therapeutic neck dissections in 11 cases and elective in 14 cases). In all cases, surgery was performed with sufficient tumour-free resection margins. Adjuvant radiotherapy was administered postoperatively in 16 patients. Occult metastases were present in 21% of cases after an elective neck dissection, but not in any case in the deep lobe of the parotid gland. The five-year overall survival and recurrence-free interval were 52% and 55%, respectively. Patients with the cN3b stage and G3 histological grade tend to have a worse prognosis, but not at a statistically significant level. The prognosis was not worse in patients with concurrent parotid and cervical metastases compared to those with metastases limited to the parotid gland only. The addition of adjuvant irradiation, in comparison to a single modality surgical treatment, was the only statistically significant prognostic factor that reduced the risk of death from this diagnosis (=0.013). The extent of parotidectomy (partial vs. total) had no impact on either the risk of recurrence or patient prognosis. The combination of surgery with irradiation provides the best results and should be applied to all patients who tolerate the treatment. A partial superficial parotidectomy should be sufficient, with a minimum risk of occult metastasis in the deep lobe. Conversely, the relatively high incidence of occult neck metastases indicates that patients could likely benefit from elective neck dissection.
皮肤鳞状细胞癌（cSCC）是一种预后良好的恶性肿瘤，除非发生淋巴结转移。我们的研究目的是确定腮腺转移的临床分期和头颈部 cSCC 隐匿性颈部淋巴结受累的发生率的预后意义。我们的回顾性分析包括 39 例腮腺转移的 cSCC 患者，其中 15 例伴有颈淋巴结同时受累。在 32 例患者中，淋巴结表现为 N3b 期。共有 26 例患者接受了腮腺切除术，9 例单独接受了放疗，4 例接受了对症治疗。手术治疗包括全保留（21 例）或浅腮腺切除术（5 例）和颈部淋巴结清扫术（11 例治疗性和 14 例选择性）。在所有病例中，均进行了充分的无肿瘤切除边缘的手术。16 例患者术后接受辅助放疗。选择性颈部清扫术后，隐匿性转移的发生率为 21%，但在腮腺深叶中无一例发生。五年总生存率和无复发生存率分别为 52%和 55%。cN3b 期和 G3 组织学分级的患者预后较差，但无统计学意义。同时有腮腺和颈部转移的患者与仅局限于腮腺的转移患者相比，预后没有更差。与单一模式手术治疗相比，辅助放疗的增加是降低该诊断死亡风险的唯一具有统计学意义的预后因素（=0.013）。腮腺切除术的范围（部分与全切除）对复发风险或患者预后均无影响。手术联合放疗可获得最佳结果，应适用于所有能耐受治疗的患者。最小风险的深部腮腺隐匿性转移应足以进行部分浅腮腺切除术。相反，隐匿性颈部淋巴结转移的相对高发表明患者可能受益于选择性颈部清扫术。
