Distant Metastases and Survival Prediction in Head and Neck Squamous Cell Carcinoma

Objective. This study was designed to identify the risk factors associated with distant metastases (DM) and survival outcomes in patients with head and neck squamous cell carcinoma (HNSCC). Study Design. Database analysis plus chart review. Setting. Tertiary care academic medical center. Subjects and Methods. Four hundred four eligible patients were involved who were treated with a minimum 2-year follow-up from January 2005 through August 2009. Confirmation of DM was performed by histopathology or follow-up imaging. Univariate and multivariate analyses were used for factors predictive of DM. The survival of patients was calculated by the Kaplan-Meier method. Results. Thirty-six of the 404 eligible patients (8.9%) developed DM, most frequently in the lungs (80.6%). Univariate analyses revealed that T and N classifications, lymphovascular invasion and perineural invasion of the primary tumor, and locoregional recurrences were each significantly associated with the development of DM (P < .05). Multivariate analyses showed that T and N classifications and locoregional recurrences were independent predictors of DM (P < .05). The overall 1- and 2-year survival rates of the 36 patients with DMs were 40.6% and 13.5%, respectively. Metastases to more than 1 organ negatively affected patient survival (P < .001). Conclusion. Patients with advanced tumors, nodal involvement, or locoregional recurrences may require more frequent surveillance for the development of DMs.