{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T21:10:54Z","timestamp":1790111454917,"version":"4.0.1"},"reference-count":32,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2017,2,7]],"date-time":"2017-02-07T00:00:00Z","timestamp":1486425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Patients who are chronically immunosuppressed have higher rates of cutaneous squamous cell carcinoma of the head and neck (cSCC\u2010HN). This is the largest multi\u2010institutional study to date investigating the effect of immune status on disease outcomes in patients with cSCC\u2010HN who underwent surgery and received postoperative radiation therapy (RT).<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Patients from 3 institutions who underwent surgery and also received postoperative RT for primary or recurrent, stage I through IV cSCC\u2010HN between 1995 and 2015 were included in this institutional review board\u2010approved study. Patients categorized as immunosuppressed had chronic hematologic malignancy, human immunodeficiency\/acquired immunodeficiency syndrome, or had received immunosuppressive therapy for organ transplantation \u22656 months before diagnosis. Overall survival, locoregional recurrence\u2010free survival, and progression\u2010free survival were calculated using the Kaplan\u2010Meier method. Univariate and multivariate analyses were performed using Cox proportional\u2010hazards regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Of 205 patients, 138 (67.3%) were immunocompetent, and 67 (32.7%) were immunosuppressed. Locoregional recurrence\u2010free survival (47.3% vs 86.1%; <jats:italic>P<\/jats:italic> &lt; .0001) and progression\u2010free survival (38.7% vs 71.6%; <jats:italic>P<\/jats:italic> = .002) were significantly lower in immunosuppressed patients at 2 years. The 2\u2010year OS rate in immunosuppressed patients demonstrated a similar trend (60.9% vs 78.1%; <jats:italic>P<\/jats:italic> = .135) but did not meet significance. On multivariate analysis, immunosuppressed status (hazard ratio [HR], 3.79; <jats:italic>P<\/jats:italic> &lt; .0001), recurrent disease (HR, 2.67; <jats:italic>P<\/jats:italic> = .001), poor differentiation (HR, 2.08; <jats:italic>P<\/jats:italic> = .006), and perineural invasion (HR, 2.05; <jats:italic>P<\/jats:italic> = .009) were significantly associated with locoregional recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Immunosuppressed patients with cSCC\u2010HN had dramatically lower outcomes compared with immunocompetent patients, despite receiving bimodality therapy. Immune status is a strong prognostic factor that should be accounted for in prognostic systems, treatment algorithms, and clinical trial design. <jats:bold><jats:italic>Cancer<\/jats:italic> 2017;123:2054\u20132060<\/jats:bold>. \u00a9 <jats:italic>2017 American Cancer Society<\/jats:italic>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.30601","type":"journal-article","created":{"date-parts":[[2017,2,7]],"date-time":"2017-02-07T14:42:49Z","timestamp":1486478569000},"page":"2054-2060","source":"Crossref","is-referenced-by-count":132,"title":["A multi\u2010institutional comparison of outcomes of immunosuppressed and immunocompetent patients treated with surgery and radiation therapy for cutaneous squamous cell carcinoma of the head and neck"],"prefix":"10.1002","volume":"123","author":[{"given":"Bindu V.","family":"Manyam","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam A.","family":"Garsa","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of California San Francisco San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Re\u2010I","family":"Chin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Washington University St. Louis Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandana A.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Gastman","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wade","family":"Thorstad","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Washington University St. Louis Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue S.","family":"Yom","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of California San Francisco San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Nussenbaum","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Washington University St. Louis Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of California San Francisco San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison T.","family":"Vidimos","sequence":"additional","affiliation":[{"name":"Department of Dermatology Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shlomo A.","family":"Koyfman","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,2,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24171"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(08)70178-5"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0041-1345(98)00178-X"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra022137"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2016.02.1155"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-9740.2005.03471.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2005.07021.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2015.3902"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4632.2011.04939.x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2010.11.062"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181ec7228"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4725.2004.30149.x"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2013.2139"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2013.6249"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21965"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2010.09.040"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20608"},{"key":"e_1_2_8_19_1","unstructured":"National Comprehensive Cancer Network (NCCN).NCCN Clinical Practice Guidelines in Oncology. Squamous Cell Skin Cancer. Version 1.2016. Available at:https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/squamous.pdf. Accessed September 14 2016."},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2015.04.037"},{"key":"e_1_2_8_21_1","unstructured":"Trans\u2010Tasman Radiation Oncology Group (TROG).Post\u2010operative Concurrent Chemo\u2010radiotherapy Versus Post\u2010operative Radiotherapy for Cancer of the Head and Neck (NCT00193895). Available at:https:\/\/clinicaltrials.gov\/ct2\/show\/NCT00193895. Accessed September 14 2016."},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-11-1951"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2010.34.1735"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1003466"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00083-2"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(16)30066-3"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1509268"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2015.2705"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24208"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2015.4994"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.48.5326"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.det.2011.02.004"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2010.11.063"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fcncr.30601","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.30601","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T14:26:07Z","timestamp":1760279167000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.30601"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,2,7]]},"references-count":32,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2017,6]]}},"alternative-id":["10.1002\/cncr.30601"],"URL":"https:\/\/doi.org\/10.1002\/cncr.30601","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,2,7]]}}}