Predictive factors for long-term survival in head and neck squamous cell carcinoma patients with distant metastasis after initial definitive treatment

Purpose Distant metastasis (DM) of head and neck squamous cell carcinoma (HNSCC) is not common but remains a substantial problem. Here, we evaluated factors predictive of long-term survival in HNSCC patients presenting with DM after initial definitive treatment. Methods The medical records of patients with HNSCC who underwent definitive treatment between 2006 and 2011 were reviewed. Univariate and multivariate analyses were performed to identify clinicopathological factors associated with long-term survival after DM. Results Of 779 HNSCC patients, 98 (12.6 %) had DM after completion of definitive treatment, with a median time to DM of 15 months (range 1-87 months). Overall survival (OS) rates at 1 and 2 years after DM were 43.1 and 20.5 %, respectively. In multivariate analysis, hypoalbuminemia (P < 0.001, hazard ratio [HR] 3.45, 95 % confidence interval [CI] 2.01-5.92), prior or simultaneous locoregional failure events (P < 0.001, HR 2.36, 95 % CI 1.47-3.79), multisite DM (P = 0.001, HR 2.30, 95 % CI 1.42-3.72), and no salvage treatment for DM (P = 0.003, HR 2.19, 95 % CI 1.32-3.64) were independent predictors of OS after the development of DM. Seventeen (18 %) patients survived > 2 years. Patients who did not have any of these risk factors had the most favorable outcomes, with a 2-year survival of 100 %. Conclusions In the absence of risk factors, long-term survival can be achieved despite the development of DM after definitive treatment.