The impact of surgical margins in managing regional metastases in cutaneous squamous cell carcinoma of the head and neck.

IF 2.2 3区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Laryngoscope Pub Date : 2025-01-15 DOI:10.1002/lary.32006

Rachel Braude, Timothy G H Manzie, Jonathan R Clark, Kerwin Shannon, Carsten E Palme, Michael Elliott, James Wykes, Sydney Ch'ng, Ruta Gupta, Veronica Cheung, Tsu-Hui Low

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Abstract

Background: Regional metastasis occurs in 5% of cutaneous squamous cell carcinoma (cSCC). The aim of this study is to assess the impact of margin status of regional metastases on survival.

Methods: A retrospective review of 401 patients with nodal metastases from cSCC. Margin status of nodal metastases was classified as clear (>1 mm), close (<1 mm), or involved. Cox regression and Kaplan-Meier methods were used to assess associations with overall and disease-specific survival (OS and DSS).

Results: Of the 401 patients with nodal metastases (median age 75, 85.3% male), 43.6% had involved margins, 27.4% had close margins, and 28.9% had clear margins. Involved margins were significantly associated with reduced OS and DSS on univariable analysis. Multivariable analysis confirmed that involved margins independently predicted worse DSS (HR 1.92, 95% CI 1.15-3.19, p = 0.01). Other independent prognostic factors included size of deposit (HR 1.02, 95% CI 1.01-1.04, p < 0.001), number of deposits (HR 1.05, 95% CI 1.02-1.08, p < 0.001), and the presence of perineural invasion (HR 1.84, 95% CI 1.14-2.98, p = 0.01).

Conclusions: Clear surgical margins during the removal of regional metastases of cSCC improves survival outcomes. This study highlights the importance of careful preoperative evaluation to achieve a complete (R0) surgical resection.

Level of evidence: Level 3 Laryngoscope, 2025.

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手术切缘对头颈部皮肤鳞状细胞癌区域转移的影响。

背景：5%的皮肤鳞状细胞癌（cSCC）发生区域转移。本研究的目的是评估区域转移的边缘状态对生存的影响。方法：对401例cSCC淋巴结转移患者进行回顾性分析。结果：401例淋巴结转移患者（中位年龄75岁，85.3%为男性）中，43.6%的患者有转移缘，27.4%的患者有接近转移缘，28.9%的患者有清晰转移缘。在单变量分析中，累及切缘与OS和DSS的降低显著相关。多变量分析证实，受累边缘独立预测较差的DSS （HR 1.92, 95% CI 1.15-3.19, p = 0.01）。其他独立预后因素包括沉积物的大小（HR 1.02, 95% CI 1.01-1.04, p）。结论：清除cSCC区域转移的手术切缘可改善生存结果。本研究强调了术前仔细评估以实现完全（R0）手术切除的重要性。证据等级：三级喉镜，2025。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Laryngoscope 医学-耳鼻喉科学

CiteScore

6.50

自引率

7.70%

发文量

500

审稿时长

2-4 weeks

期刊介绍： The Laryngoscope has been the leading source of information on advances in the diagnosis and treatment of head and neck disorders since 1890. The Laryngoscope is the first choice among otolaryngologists for publication of their important findings and techniques. Each monthly issue of The Laryngoscope features peer-reviewed medical, clinical, and research contributions in general otolaryngology, allergy/rhinology, otology/neurotology, laryngology/bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. Contributions include papers and posters presented at the Annual and Section Meetings of the Triological Society, as well as independent papers, "How I Do It", "Triological Best Practice" articles, and contemporary reviews. Theses authored by the Triological Society’s new Fellows as well as papers presented at meetings of the American Laryngological Association are published in The Laryngoscope. • Broncho-esophagology • Communicative disorders • Head and neck surgery • Plastic and reconstructive facial surgery • Oncology • Speech and hearing defects