While only a small percentage of patients present with metastatic cutaneous squamous cell carcinoma (cSCC) of the head and neck (McSCCHN), the association of lymph node metastasis (LNM) with reduced survival necessitates diligent study of this patient population. Sahovaler et al1 conducted a systematic review and meta-analysis of all published studies on the risk factors for overall survival (OS), locoregional control, locoregional recurrence, and disease-specific survival (DSS) for patients with McSCCHN. Patient demographics, immune status, nodal status, pathologic characteristics, treatment, and outcomes were assessed among 20 observational studies and 1 randomized clinical trial representing 3534 patients. The meta-analysis identified that immunosuppression (IS), extracapsular spread (ECS), lymph node ratio, and advanced age were associated with a worse OS, while adjuvant radiotherapy (AR) was associated with a higher OS. Immunosuppression remained significantly associated with decreased DSS, while AR was associated with increased DSS. Interestingly, nodal classification was not found to be associated with OS. Unfortunately, the studies cited by the American Joint Commission on Cancer (AJCC)2 and National Comprehensive Cancer Network (NCCN)3 that stratify patients according to nodal stage could not be included in this review owing to the lack of hazard ratios and/or confidence intervals. Nevertheless, the findings reported in this meta-analysis confirm previous reports of decreased OS and DSS in IS populations, including solid organ transplant patients.4
Barber BR. Immune Status and Immunotherapy in Advanced Cutaneous Squamous Cell Carcinoma—What Are Our Next Steps? JAMA Otolaryngol Head Neck Surg. 2019;145(4):361–362. doi:10.1001/jamaoto.2018.4514
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