This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Head and Neck Squamous Cell Carcinoma with Distant Metastasis: A Systematic Review and Meta-Analysis
by
, , , , , and
Antonio Daloiso
1
,
Leonardo Franz
2
,
Tiziana Mondello
1,
Matteo Tisato
1,
Michael Negrisolo
1,
Paolo Zanatta
3,
Cosimo de Filippis
2, 
Laura Astolfi
4 and
Gino Marioni
2,*
1
Otolaryngology Section, Department of Neuroscience DNS, University of Padova, 35131 Padova, Italy
2
Phoniatrics and Audiology Unit, Department of Neuroscience DNS, University of Padova, 31100 Treviso, Italy
3
Department of Anesthesiology and Critical Care, Treviso Hospital, 31100 Treviso, Italy
4
Bioacoustics Research Laboratory, Department of Neuroscience DNS, University of Padova, 35131 Padova, Italy
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(22), 3887; https://doi.org/10.3390/cancers16223887
Submission received: 24 October 2024
/
Revised: 13 November 2024
/
Accepted: 18 November 2024
/
Published: 20 November 2024
(This article belongs to the Section Systematic Review or Meta-Analysis in Cancer Research)
Simple Summary
Distant metastasis (DM), though uncommon at initial presentation, significantly worsens the prognosis of head and neck squamous cell carcinomas (HNSCCs). This systematic review and meta-analysis aimed to investigate the occurrence rates, patterns, and implications of DM. Out of 7576 identified titles, 35 studies were included, encompassing 28,193 HNSCC patients. The pooled rate of DM was 10.01%, with significant heterogeneity existing among the studies. The most common metastatic sites were the lungs, bones, and brain. Treatment modalities varied: overall, 20.4% of patients received radiotherapy alone, 7% underwent chemotherapy, and 4.5% received surgical metastasectomies. Combined treatments for DM accounted for 18.3% of patients. However, 41.3% of patients received no treatment. The median overall survival after DM diagnosis was 10.1 months. The strength of the available evidence is currently too weak to drive robust clinical recommendations. Advanced imaging techniques and emerging systemic therapies offer hope for the improved detection and treatment of DM.
Abstract
Background/Objectives: Distant metastasis (DM), though uncommon at initial presentation, significantly worsens the prognosis of head and neck squamous cell carcinomas (HNSCCs). This review aimed to investigate the occurrence rates, patterns, and implications of HNSCC DM. Methods: A systematic search was performed in Scopus, PubMed and Web of Science. Results: Out of 7576 identified titles, 35 studies were included, encompassing 28,193 patients. The pooled rate of DM was 10.01%, with significant heterogeneity existing among the studies (I2: 94.13%). The most common metastatic sites were the lungs, bones, and brain (58%, 15%, 4%, respectively). Treatment modalities varied: overall, 20.4% of patients received radiotherapy alone, 7% underwent chemotherapy, and 4.5% received surgical metastasectomies. Combined treatments accounted for 18.3% of patients. However, 41.3% of patients received no treatment for DM. The median overall survival (OS) after DM diagnosis was 10.1 months. Studies highlighted a 36.3% two-year survival rate for patients with oligo-metastases, compared to the 7.4% rate for those with multiple metastases. At the time of DM diagnosis, half of the studied population presented with locoregional failure. Conclusions: Advanced imaging techniques and emerging systemic therapies offer hope for improved DM detection and treatment. However, continuous research is essential to develop therapeutic strategies that can enhance survival and improve the quality of life for patients with DM.
