Parotid metastatic disease from cutaneous squamous cell carcinoma: Prognostic role of facial nerve sacrifice, lateral temporal bone resection, immune status and P-stage

Background Recognized prognostic indicators for metastatic cutaneous squamous cell carcinoma (SCC) of the head and neck include facial nerve involvement, immune status, and “parotid” staging system (P‐stage). We sought to examine the impact of lateral temporal bone resection (LTBR) on prognosis. Met...

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Bibliographic Details
Published in:	Head & neck Vol. 36; no. 4; pp. 545 - 550
Main Authors:	Shao, Angus, Wong, Danny K. C., McIvor, Nicholas P., Mylnarek, Alex M., Chaplin, John M., Izzard, Mark E., Patel, Rajan S., Morton, Randall P.
Format:	Journal Article
Language:	English
Published:	United States Blackwell Publishing Ltd 01-04-2014 Wiley Subscription Services, Inc
Subjects:	Aged Aged, 80 and over Carcinoma, Squamous Cell - mortality Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - secondary Carcinoma, Squamous Cell - therapy cutaneous squamous cell carcinoma Dissection Facial Nerve - surgery Female Humans immunocompromise Immunocompromised Host Kaplan-Meier Estimate lateral temporal bone resection Male Neck Dissection P-stage parotid Parotid Gland - surgery Parotid Neoplasms - mortality Parotid Neoplasms - secondary Parotid Neoplasms - therapy Prognosis Proportional Hazards Models Retrospective Studies Skin Neoplasms - pathology Temporal Bone - surgery lateral temporal bone resection immunocompromise cutaneous squamous cell carcinoma parotid P-stage
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Summary:	Background Recognized prognostic indicators for metastatic cutaneous squamous cell carcinoma (SCC) of the head and neck include facial nerve involvement, immune status, and “parotid” staging system (P‐stage). We sought to examine the impact of lateral temporal bone resection (LTBR) on prognosis. Methods We conducted a retrospective analysis of 160 patients with metastatic cutaneous SCC to the parotid. All patients had parotidectomy and neck dissection; 27% had additional LTBR when the tumor was adherent to the temporal bone. Results Overall 5‐year survival was 48%, disease‐specific survival 77%, and locoregional control 83%. Corresponding results for immunocompetent versus immunocompromised were 55%, 86%, and 87% versus 12%, 48%, and 64%. On Cox regression analysis, only immunocompromised status (ie, lymphoproliferative disorder, organ‐transplant patient) was prognostically significant (p < .001). Conclusion More radical resection that may include LTBR mitigates the poorer prognosis with advanced disease in our series. Treatment must be individualized in immunocompromised patients who have shortened overall survival. © 2013 Wiley Periodicals, Inc. Head Neck 36: 545–550, 2014
Bibliography:	ark:/67375/WNG-C41GGR4Q-N istex:87AA097C59D732AADED911A9FA300ED91DF5B795 ArticleID:HED23323 The results of this study were presented at the 12th Asia‐Oceania Otolaryngology Congress, Auckland, New Zealand, March 4, 2011. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1043-3074 1097-0347
DOI:	10.1002/hed.23323