Clinical and Pathologic Predictors of Recurrence and Survival in Spindle Cell Squamous Cell Carcinoma

Objective. To determine clinicopathologic predictors of recurrence and survival in patients with spindle cell squamous cell carcinoma (SpSCC). Study Design. Historical cohort study. Setting. Tertiary care hospital. Subjects and Methods. Forty-eight patients (mean age, 65.2 years; 35 men, 13 women) who underwent definitive treatment for pathologically confirmed SpSCC between 1987 and 2009 were identified and reviewed. The main outcome measures were time to recurrence and overall survival, while controlling for clinical and pathologic parameters (age, sex, TNM classification, stage, tumor subsite, smoking status, treatment modality, margin status). Results. Of 48 patients, there were 25 oral cavity, 15 laryngeal, 7 oropharyngeal, and 1 maxillary sinus tumors. Treatment included surgery in 32, radiation in 9, and concurrent chemoradiation in 7 patients. The 3-year overall survival for the cohort was 62% with a median follow-up of 59 months; 52.1% (25/48) of patients developed a recurrence, and 88% (22/25) recurred locally or locoregionally. Recurrence occurred within 2 years in 72% (18/25) of patients. Age, sex, initial T and N classification, overall stage, tumor subsite, smoking status, treatment modality, and margin status were not predictive of recurrence or overall survival. Conclusion. Patients with SpSCC are at high risk of developing locoregional recurrence, but no measured clinical or pathologic parameter was predictive of survival. Although overall survival is similar to that of patients with conventional SCC, closer follow-up should be considered in these patients to allow earlier detection and treatment of these locally aggressive tumors.