Evolution of Head and Neck Cutaneous Squamous Cell Carcinoma Nodal Staging—An Australian Perspective
by
, ,
Michael J. L. Hurrell
1,*
,
Tsu-Hui (Hubert) Low
1,2,3,
Ardalan Ebrahimi
4,
Michael Veness
5,
Bruce Ashford
6,7,8,
Sandro Porceddu
9,10 and
Jonathan R. Clark
1,3,11 1
Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW 2050, Australia
2
Department of Otolaryngology—Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia
3
Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW 2006, Australia
4
Medical School, College of Health and Medicine, Australian National University, Canberra, ACT 2601, Australia
5
Westmead Hospital, University of Sydney, Westmead, NSW 2006, Australia
6
School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia
7
Illawarra Health and Medical Research Institute, Wollongong, NSW 2500, Australia
8
Illawarra Shoalhaven Local Health District, Wollongong, NSW 2502, Australia
9
Radiation Oncology, University of Queensland, St Lucia, QLD 4072, Australia
10
Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
11
Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW 2050, Australia
*
Author to whom correspondence should be addressed.
Cancers 2022, 14(20), 5101; https://doi.org/10.3390/cancers14205101
Submission received: 15 September 2022
/
Revised: 11 October 2022
/
Accepted: 15 October 2022
/
Published: 18 October 2022
(This article belongs to the Special Issue Clinical Application of Head and Neck Cancer Research)
Simple Summary
Australia has the highest incidence of cutaneous squamous cell carcinoma of the head and neck (HNcSCC) in the world. Although the majority of HNcSCCs are cured by simple surgical excision, those that spread to lymph nodes require aggressive and debilitating surgery in conjunction with radiation therapy, with a significant risk of treatment failure and subsequent loss of life. Cancer staging is critical to guide prognosis, treatment (to maximise disease control and minimise morbidity), and for research. Australian institutions have been at the forefront of prognostication for HNcSCC with lymph node spread. Despite this, the search for a well performing staging system is ongoing. This review chronologically explores and summarises the Australian contribution to date and highlights the ongoing challenges.
Abstract
Cutaneous squamous cell carcinoma of the head and neck (HNcSCC) is one of the commonest malignancies. When patients present with regional metastatic disease, treatment escalation results in considerable morbidity and survival is markedly reduced. Owing to the high incidence, Australian institutions have been at the forefront of advocating for reliable, accurate, and clinically useful staging systems that recognise the distinct biological characteristics of HNcSCC. As a result, an extensive body of literature has been produced over the past two decades, which has defined critical prognostic factors, critiqued existing staging systems, and proposed alternative staging models. Notwithstanding, a suitable staging system has proved elusive. The goal of cancer staging is to group patients according to cancer characteristics for which survival differs between groups (distinctiveness), consistently decreases with increasing stage (monotonicity), and is similar within a group (homogeneity). Despite implementing major changes based on published data, the latest edition of the American Joint Committee on Cancer (AJCC) staging manual fails to satisfy these fundamental requirements. This review chronologically explores and summarises the Australian contribution to prognostication and nodal staging of HNcSCC and highlights the ongoing challenges.
