Characterizing Distant Metastasis at Presentation in Head and Neck Cancers

Introduction: Distant metastasis at presentation (DM) is a strong predictor of mortality in head and neck squamous cell carcinoma (HNSCC). Here, we report an updated analysis of the epidemiological features of DM-HNSCC, characterizing site-specific incidence and risk factors.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for patients with HNSCC of the larynx, pharynx, and oral cavity from 2004-2015. Descriptive analyses comparing HNSCC presenting with or without DM were performed and factors independently associated with DM at presentation were calculated using multivariable logistic regression models, presented as odds ratios (OR) [95% confidence intervals].

Results: Among 207,019 HNSCC patients identified, 4,301 (2.12%) presented with DM. Race, age, primary tumor site and size, and lymph node category were independently associated with DM-positive status at presentation. Non-Hispanic (NH) Black (OR= 1.5 [1.3-1.7], p< 0.001), Hispanic (OR=1.4 [1.2-1.6], p< 0.001), and NH-Native American patients (OR=1.3 [1-1.6], p=0.04) were more likely to present with DM than NH-White patients. Patients younger than 60 were less likely to present with DM (ages 20-40: OR=0.4 [0.2-0.6],p < 0.001; 41-60: OR=0.7 [0.6-0.8], p< 0.001). Compared to the oropharyngeal primary site, those with hypopharyngeal (OR=2.4 [2-2.8], p< 0.001) and laryngeal (OR=1.5 [1.3-1.7], p< 0.001) tumors had higher odds of DM while oral cavity primaries had lower odds (OR=0.6 [0.6-0.7], p< 0.001). Primary tumors >1 cm in size had higher odds of DM (1-5 cm: OR=2.5 [2-3.2], p< 0.001; >5 cm: OR: 4.8 [3.8-6.3], p< 0.001). Any positive nodal status had higher odds of DM (p < 0.001).

Conclusions: Using SEER, we find an overall distant metastasis rate of 2.1% in HNSCC over a 10 year period. Our analysis reveals non-White race; hypopharyngeal or laryngeal primary tumors; advanced nodal involvement; age >60 years; and primary tumor sizes >1cm as strong factors associated with DM at presentation. To our knowledge, this is the largest analysis of DM at presentation in HNSCC within the last two decades.