Prognosis of metastatic head and neck squamous cell carcinoma over the last 30 years

Background: Head and neck cutaneous squamous cell carcinoma (HNcSCC) is one of the most common malignancies in Australia and consequently it is important to know whether patient outcomes have improved with time. Methods: All patients with metastatic HNcSCC treated with curative intent were identified from the Sydney Head and Neck Cancer Institute database (1987–2016). Patients were grouped into 10-year blocks from 1987, and disease-specific survival (DSS) and overall survival were analysed. Estimated survivals were calculated using the Kaplan–Meier method and Cox regression. Results: Since 1987, there has been an increase in the proportion of elderly patients (>75 years, P = 0.006) and the rate of adverse prognostic features including median node size (P = 0.047) and number of involved nodes (P < 0.001). Whereas the rate of adjuvant radiotherapy (RT) and comprehensive neck dissection has decreased (P = 0.014 and P < 0.001, respectively). Despite this, 5-year DSS improved over the last 30 years from 57% during 1987–1996 to 88% during 2007–2016 (P < 0.001). This was particularly evident in patients treated with surgery followed by RT (P = 0.001), patients with extracapsular spread or soft tissue deposits (P < 0.001) and in patients with a single positive node (DSS, P = 0.007). On multivariable analysis, DSS has improved over time (hazard ratio 0.466 per 10 years bracket, 95% confidence interval 0.324–0.672, P < 0.001) after adjusting for the effect of age, presence of extracapsular spread or soft tissue deposits and adjuvant RT. Conclusion: Medical advances have enabled us to treat older patients and more advanced metastatic HNcSCC and their prognosis appears to have improved over the past 30 years.