Distant Metastases of Head and Neck Squamous Cell Carcinomas-Experience from Eastern Taiwan

Objective: To evaluate the clinical manifestations and possible risk factors for distant metastases in patients with head and neck squamous cell carcinomas (HNSCCs) from eastern Taiwan, a region with a high prevalence of these malignancies. Patients and Methods: In total, 735 patients with HNSCCs who were treated between 1991 and 2000, all of whom had at least 2 years of follow-up, were included in this study. The clinical data were reviewed and possible risk factors for the development of distant metastases were analyzed. Results: The overall incidence of distant metastasis was 20%. The median interval between diagnosis and the occurrence of distant metastases was 8 months. The lungs (36.4%), bone (34.0%), and liver (23.8%) remained the most-frequent metastatic sites, but different primary cancer sites had more-prevalent metastatic locations (e.g., NPC to bone and laryngeal cancer to the liver). Most of the patients developed distant metastasis in only 1 organ system, but NPC patients often had involvement of multiple systems. The occurrence of distant metastases was significantly related to locoregional control, TNM stage, N (nodal) classification, and the primary sites being the hypopharynx and nasopharynx. The median survival after a diagnosis of distant metastasis was 14 months, and it was longer in patients with only distant metastasis compared to those who failed at both locoregional and distant sites. Conclusions: The rate and location of metastasis of different head and neck squamous cell carcinomas vary. But the prognosis of these patients remains poor. These findings suggest the need for more-aggressive treatments especially for those who have both locoregional and distant failure.