Predictive factors of isolated distant metastasis after primary definitive surgery without systemic treatment for head and neck squamous cell carcinoma

Lim, Jae-Yol; Lim, Young Chang; Kim, Se-Heon; Kim, Jae Wook; Jeong, Ha Min; Choi, Eun Chang

doi:10.1016/j.oraloncology.2010.02.005

« Previous Next »Oral Oncology
Volume 46, Issue 7 , Pages 504-508, July 2010

Predictive factors of isolated distant metastasis after primary definitive surgery without systemic treatment for head and neck squamous cell carcinoma

Jae-Yol Lim
- Department of Otorhinolaryngology, Head and Neck Surgery, Inha University College of Medicine, Incheon, Republic of Korea
Young Chang Lim
- Department of Otorhinolaryngology, Head and Neck Surgery, Konkuk University College of Medicine, Seoul, Republic of Korea
Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei Head and Neck Cancer Clinic, Yonsei University College of Medicine, Seoul, Republic of Korea
Jae Wook Kim
- Department of Otorhinolaryngology, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
Ha Min Jeong
- Department of Otorhinolaryngology, Yonsei Head and Neck Cancer Clinic, Yonsei University College of Medicine, Seoul, Republic of Korea
Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei Head and Neck Cancer Clinic, Yonsei University College of Medicine, Seoul, Republic of Korea
- Corresponding author. Address: Department of Otorhinolaryngology, Yonsei Head and Neck Cancer Clinic, Yonsei University College of Medicine, 250 Seongsan-no, Seodaemun-gu, Seoul 120-752, Republic of Korea. Tel.: +82 2 2228 3608; fax: +82 2 393 0580.

Received 5 January 2010; received in revised form 11 February 2010; accepted 12 February 2010. published online 20 April 2010.

Summary

Incidence of isolated distant metastasis (IDM) was relatively low in patients who achieved locoregional control after primary definitive surgery. However, the prognosis of patients with IDM was dismal. The aim of this study was to evaluate the clinical outcome of patients with IDM and identify independent predictive factors of IDM after primary definitive surgery for head and neck squamous cell carcinoma (HNSCC).

A retrospective data review was conducted for 795 patients who underwent primary definitive surgery without any systemic treatment for squamous cell carcinoma (SCC) of the oral cavity, oropharynx, larynx, and hypopharynx. Distant metastasis-free survival was calculated and independent predictive factors for IDM were determined by Cox proportional-hazards model.

For the entire study cohort, IDM developed in 75 patients (9.4%). Among 631 patients who achieved locoregional control, IDM occurred in 44 patients (7%). The median time to IDM after primary surgery was 13months, ranging from 2 to 70months. The overall salvage rate was 9% (4 of 44) after salvage treatment for IDM. In the Cox proportional-hazards model, clinical N status, and histological grade were independent predictive factors of IDM.

Patients who had clinically palpable neck disease and a histologically poor grade were more likely to develop IDM after primary definitive surgery. Patients with these factors should be considered candidates for proper adjuvant systemic treatment and evaluated more thoroughly for early detection of IDM during follow-up.

Keywords: Distant metastasis, Head and neck neoplasm, Squamous cell carcinoma