{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T20:58:44Z","timestamp":1787605124274,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T00:00:00Z","timestamp":1723161600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>We aimed to identify predictors of distant metastatic recurrence (DMR) in patients with head and neck cutaneous squamous cell carcinoma (HNcSCC) with nodal metastases treated with curative intent.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Predictors of DMR were identified using Cox regression in a multicenter study of 1151 patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 5\u2010year risk of DMR was 9.6%. On multivariate analysis, immunosuppression (HR 2.93; 95% CI: 1.70\u20135.05; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), nodal size &gt;6\u2009cm [versus \u22643\u2009cm (HR 2.77; 95% CI: 1.09\u20137.03; <jats:italic>p<\/jats:italic>\u2009=\u20090.032)], \u22655 nodal metastases [versus 1\u20132 (HR 2.79; 95% CI: 1.63\u20134.78; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001)], and bilateral disease (HR 3.11; 95% CI: 1.40\u20136.90; <jats:italic>p<\/jats:italic>\u2009=\u20090.005) predicted DMR. A DMR risk score was developed that stratified risk from 6.6% (no risk factors) to 100% (\u22653 risk factors) (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The risk of DMR in nodal metastatic HNcSCC increases with immunosuppression, nodal size &gt;6\u2009cm, \u22655 nodal metastases, and bilateral disease. A simple DMR risk score estimated prior to treatment may be clinically useful.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hed.27912","type":"journal-article","created":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T11:28:24Z","timestamp":1723202904000},"page":"254-262","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Predictors of distant metastatic recurrence in head and neck cutaneous squamous cell carcinoma with lymph node metastases treated with curative intent: A multicenter study"],"prefix":"10.1002","volume":"47","author":[{"given":"Ardalan","family":"Ebrahimi","sequence":"first","affiliation":[{"name":"Medical School, College of Health and Medicine Australian National University  Canberra Australian Capital Territory Australia"},{"name":"Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute Chris O'Brien Lifehouse  Sydney New South Wales Australia"},{"name":"Department of Head and Neck Surgery The Canberra Hospital  Canberra Australian Capital Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruta","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Tissue Pathology and Diagnostic Oncology Royal Prince Alfred Hospital  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health Sciences The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4268-3079","authenticated-orcid":false,"given":"Lachlan","family":"McDowell","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Peter MacCallum Cancer Centre  Melbourne Victoria Australia"},{"name":"Sir Peter MacCallum Department of Oncology The University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J. R.","family":"Magarey","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Peter MacCallum Cancer Centre  Melbourne Victoria Australia"},{"name":"Department of Medical Education University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul N.","family":"Smith","sequence":"additional","affiliation":[{"name":"Medical School, College of Health and Medicine Australian National University  Canberra Australian Capital Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus\u2010Martin","family":"Schulte","sequence":"additional","affiliation":[{"name":"Medical School, College of Health and Medicine Australian National University  Canberra Australian Capital Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana M.","family":"Perriman","sequence":"additional","affiliation":[{"name":"Medical School, College of Health and Medicine Australian National University  Canberra Australian Capital Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Veness","sequence":"additional","affiliation":[{"name":"Sydney Medical School, Faculty of Medicine and Health Sciences The University of Sydney  Sydney New South Wales Australia"},{"name":"Department of Radiation Oncology Westmead Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro","family":"Porceddu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Princess Alexandra Hospital  Brisbane Queensland Australia"},{"name":"School of Medicine The University of Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsu\u2010Hui Hubert","family":"Low","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute Chris O'Brien Lifehouse  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health Sciences The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan","family":"Fowler","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Liverpool Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan R.","family":"Clark","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute Chris O'Brien Lifehouse  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health Sciences The University of Sydney  Sydney New South Wales Australia"},{"name":"Royal Prince Alfred Institute of Academic Surgery Sydney Local Health District  Camperdown New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjd\/ljac064"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200103293441306"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.21092"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24683"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23843"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21898"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21743"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.MLG.0000158349.64337.ED"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21965"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.77.0941"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.2217\/fon-2017-0468"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2014.01.004"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12348"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1805131"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-015-3773-8"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-018-0662-8"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.52199"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215116000050"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezy384"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23232"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-008-0001-4"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26117"}],"container-title":["Head &amp; 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