Performance of Salamanca refinement of the T3-AJCC8 versus the Brigham and Women's Hospital and Tübingen alternative staging systems for high-risk cutaneous squamous cell carcinoma

Puebla-Tornero, Laura; Corchete, Luis A.; Conde-Ferreirós, Alberto; García-Sancha, Natalia; Corchado-Cobos, Roberto; Román-Curto, Concépción; Cañueto, Javier

doi:10.1016/j.jaad.2020.12.020

Cited by 16 publications

(29 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our study comprises the first external validation of the Salamanca refinement system 17 . Although the Salamanca refinement system has been compared with the BWH and Tübingen systems before, this was performed on the same sample as the development of this staging system 24 . We did not observe any improvement in risk stratification for the Salamanca refinement system in our study.…”

Section: Discussionmentioning

confidence: 65%

“…Higher PPVs in studies among high-risk populations should be interpreted with caution if no adjustment for a metastasis prevalence in the general population was made. 14,24 A remarkable finding from our study was that when restricting to head and neck sites only, AJCC8 performed worse with a lower c-index compared with including all body sites. So, while AJCC8 staging is only advised for head and neck cSCCs, it could be used for all sites.…”

Section: Discussionmentioning

confidence: 66%

“…For all three staging systems, the PPVs were quite low (4.5–13.2%), as we adjusted for a 2% metastasis prevalence in the general population. Higher PPVs in studies among high‐risk populations should be interpreted with caution if no adjustment for a metastasis prevalence in the general population was made 14,24 …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Validation of four cutaneous squamous cell carcinoma staging systems using nationwide data*

Venables

Tokez²,

Hollestein

et al. 2022

Br J Dermatol

View full text Add to dashboard Cite

Summary Background Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer worldwide with relatively low metastatic potential (2–5%). Developments in therapeutic options have highlighted the need to better identify high‐risk patients who could benefit from closer surveillance, adjuvant therapies and baseline/follow‐up imaging, while at the same time safely omitting low‐risk patients from further follow‐up. Controversy remains regarding the predictive performance of current cSCC staging systems and which methodology to adopt. Objectives To validate the performance of four cSCC staging systems [American Joint Committee on Cancer 8th edition (AJCC8), Brigham and Women’s Hospital (BWH), Tübingen and Salamanca T3 refinement] in predicting metastasis using a nationwide cohort. Methods A nested case–control study using data from the National Disease Registration Service, England, 2013–2015 was conducted. Metastatic cSCC cases were identified using an algorithm to identify all potential cases for manual review. These were 1 : 1 matched on follow‐up time to nonmetastatic controls randomly selected from 2013. Staging systems were analysed for distinctiveness, homogeneity, monotonicity, specificity, positive predictive value (PPV), negative predictive value (NPV) and c‐index. Results We included 887 metastatic cSCC cases and 887 nonmetastatic cSCC controls. The BWH system showed the highest specificity [92.8%, 95% confidence interval (CI) 90.8–94.3%, PPV (13.2%, 95% CI 10.6–16.2) and c‐index (0.84, 95% CI 0.82–0.86). The AJCC8 showed superior NPV (99.2%, 95% CI 99.2–99.3), homogeneity and monotonicity compared with the BWH and Tübingen diameter and thickness classifications (P < 0.001). Salamanca refinement did not show any improvement in AJCC8 T3 cSCC staging. Conclusions We validated four cSCC staging systems using the largest nationwide dataset of metastatic cSCC so far. Although the BWH system showed the highest overall discriminative ability, PPV was low for all staging systems, which shows the need for further improvement and refining of current cSCC staging systems.

show abstract

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 66%

See 1 more Smart Citation

Validation of four cutaneous squamous cell carcinoma staging systems using nationwide data*

Venables

Tokez²,

Hollestein

et al. 2022

Br J Dermatol

View full text Add to dashboard Cite

show abstract

“…Current methods for risk assessment in cSCC are heterogenous and rely on the incorporation of high-risk tumor characteristics, as defined by current staging systems, and patient demographics, such as immune status. Despite best efforts with current tumor staging, positive predictive values for adverse outcomes remain low [ 10 , 11 ] (meaning, a significant number of patients deemed high risk do not progress to advanced disease). The most recent National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines [ 12 ] (NCCN) for cSCC (August 2021) provide an independent list of risk factors that indicate an increased risk for developing local recurrence, metastases, or disease-related death.…”

Section: Introductionmentioning

confidence: 99%

Current Methods and Caveats to Risk Factor Assessment in Cutaneous Squamous Cell Carcinoma (cSCC): A Narrative Review

Farberg

Fitzgerald²,

Ibrahim

et al. 2022

Dermatol Ther (Heidelb)

View full text Add to dashboard Cite

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer, and the number of deaths due to cSCC is estimated to be greater than the number attributed to melanoma. While the majority of cSCC tumors are resectable with clear margins by standard excision practices, some lesions exhibit high-risk factors for which there is evidence of their association with recurrence, metastasis, and disease-specific death. The most commonly used staging systems and guidelines in the USA for cSCC are based on these clinical and pathologic high-risk factors; however, these are limited in their ability to predict adverse events, thus posing a challenge for implementing risk-directed patient management. Since the development of local recurrence and/or metastasis has a profound impact on the survival of patients with cSCC, accurate identification of patients at high risk for poor outcomes is critical, potentially allowing for early and appropriate adjuvant therapy. This review summarizes the current cSCC literature with a focus on how differing clinical assessments within each of the five selected risk factors (perineural invasion, differentiation, depth of invasion, size, and location) can influence the evaluation of patient outcomes, along with summarizing the utility of staging and guidelines, and highlighting the potential for molecular tools to improve upon cSCC risk assessment.

show abstract

“…18 A study in T3-AJCC8 cSCCs comparing the AJCC8, BWH and Salamanca systems reported more reliable stratification with the BWH and Salamanca systems compared to AJCC8, but with an overall low prognostic accuracy, highlighting there is still room for improvement. 56 Perineural invasion is a risk factor for advanced cSCC, 57,58 that is, included as a high-risk factor in the guidelines and in current staging systems. However, PNI has been variably defined, highlighting the need for a standardised definition.…”

Section: Prognostic Factors Of Progressionmentioning

confidence: 99%

Epidemiology of advanced cutaneous squamous cell carcinoma

Dessinioti

Pitoulias

Stratigos

2021

Acad Dermatol Venereol

View full text Add to dashboard Cite

Cutaneous invasive squamous cell carcinoma (cSCC) most commonly presents as a typically indolent tumour with fiveyear cure rates of >90%. Advanced cSCC has been defined as locally advanced or metastatic (locoregional or distant) cSCC. The epidemiological data on advanced cSCC are rare due to underreporting or exclusion of cSCC from national cancer registries. Although the frequency of local recurrence has been reported, there is no clear evidence on the incidence or mortality of locally advanced cSCCs, e.g. locally infiltrating or locally recurrent cSCCs that are not further amenable to curative surgery or radiotherapy. This gap of knowledge on the epidemiology of locally advanced cSCC, highlights the need for standardisation in defining and reporting both locally advanced and metastatic cSCC. Even though metastatic cSCCs are a small part of cSCCs (3%-5%), their aggressive characteristics contribute to significant morbidity, higher mortality and are those likely to require systemic treatments. Locally recurrent and metastatic cSCC may occur more frequently in high-risk cSCCs (up to 35%). The site of metastasis involves in the vast majority the regional lymph nodes, with the head and neck lymph nodes or parotid most commonly affected. Metastasis occurs mostly within 2-3 years of the primary cSCC diagnosis. The knowledge of the incidence and prognosis of advanced cSCC and the risk stratification of patients, who may progress to advanced cSCC, emerge as pressing research areas with important implications for cost-efficiency planning and optimisation of patient care.

show abstract

Performance of Salamanca refinement of the T3-AJCC8 versus the Brigham and Women's Hospital and Tübingen alternative staging systems for high-risk cutaneous squamous cell carcinoma

Cited by 16 publications

References 18 publications

Validation of four cutaneous squamous cell carcinoma staging systems using nationwide data*

Validation of four cutaneous squamous cell carcinoma staging systems using nationwide data*

Current Methods and Caveats to Risk Factor Assessment in Cutaneous Squamous Cell Carcinoma (cSCC): A Narrative Review

Epidemiology of advanced cutaneous squamous cell carcinoma

Contact Info

Product

Resources

About