Sentinel lymph node biopsy for head and neck cutaneous squamous cell carcinoma using the Brigham and Women’s staging system: a cost analysis

Quinn, Patrick L.; Kim, Jin K.; Prasath, Vishnu; Panse, Neal; Knackstedt, Thomas

doi:10.1007/s00403-022-02347-x

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…26 Recently published studies do support SLNB for American Joint Committee on Cancer (8th Edition; AJCC8 27 ) Stage T3+ disease or Brigham and Women's Hospital (BWH 28 ) Stage T2b/T3 disease from a patient management 29 and health economics outcomes research perspective. 30 Also, NCCN guidelines 31 encourage discussing and considering SLNB before surgery for very-high risk cSCC, those tumors with one of the following features: perineural invasion ≥0.1mm, desmoplastic subtype, poorly differentiated, diameter ≥4 cm, lymphovascular invasion, or invasion beyond the subcutaneous fat or >6mm. While the optimal cSCC patient clinicopathologic factors that would guide the decision to perform a SLNB procedure are still unknown, future studies involving 40-GEP, in combination with staging criteria and imaging modality, may be useful in stratifying patient populations at high risk of metastasis who may benefit from SLNB.…”

Section: Sentinel Lymph Node Biopsy (Slnb)mentioning

confidence: 99%

Incorporation of the 40-Gene Expression Profile (40-GEP) Test to Improve Treatment Decisions in High-Risk Cutaneous Squamous Cell Carcinoma (cSCC) Patients: Case Series and Algorithm

Singh¹,

Tolkachjov²,

Farberg³

2023

CCID

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Cutaneous squamous cell carcinoma (cSCC) has become a significant public health issue due to its rapidly rising incidence and an estimated 1.8 million newly diagnosed cases annually. As with other cancers, treatment decisions for patients with cSCC are based primarily on a patient's risk for poor outcomes. There has been improvement in clinicopathologic factor-based risk assessment approaches, either through informal methods or ever evolving staging approaches. However, these approaches misidentify patients who will eventually have disease progression as low-risk and conversely, over classify patients as high-risk who do not experience relapse. To improve the accuracy of risk assessment for patients with cSCC, the 40-gene expression profile (40-GEP) test has been validated to show statistically significant stratification of a high-risk cSCC patient's risk of nodal or distant metastasis, independent of currently available risk-assessment methods. The 40-GEP test allows for a more accurate classification of metastatic risk for high-risk cSCC patients, with the aim to influence appropriate allocation of clinician time and therapeutic resources to those patients who will most benefit. The objective of this article is to present a treatment algorithm in which clinicians can easily integrate the results of the 40-GEP test into their current treatment approaches to tailor patient care based on individual tumor biology. The following modalities were considered: surveillance imaging, sentinel lymph node biopsy (SLNB), adjuvant radiation therapy (ART), and clinical follow-up. The authors have contributed their own cases for discussion as to how they have seen the beneficial impact of 40-GEP test results in their own practice. Overall, clinicians can identify risk-aligned treatment pathway improvements with the use of the 40-GEP test for challenging to manage, high-risk cSCC patients.

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Section: Sentinel Lymph Node Biopsy (Slnb)mentioning

confidence: 99%

Incorporation of the 40-Gene Expression Profile (40-GEP) Test to Improve Treatment Decisions in High-Risk Cutaneous Squamous Cell Carcinoma (cSCC) Patients: Case Series and Algorithm

Singh¹,

Tolkachjov²,

Farberg³

2023

CCID

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“…34,36 Utilization of the DEALE method has been further explained in previous studies by our group. 14,15,37…”

Section: Methodsmentioning

confidence: 99%

“…34,36 Utilization of the DEALE method has been further explained in previous studies by our group. 14,15,37 Comprehensive surgical complication data after completion of a preoperative FLOT regimen could not be identified in the literature for use in our PCT arm; data from the CRITICS trial, 29,31 which utilized 3 preoperative cycles of epirubicin, cisplatin or oxaliplatin, and capecitabine (ECC/EOC), was chosen as the closest approximation as Classen et al stratified their data elements by completion or lack of completion of neoadjuvant therapy. While there were concerns about additional toxicity and complications associated with FLOT, recent literature found ECC and FLOT to have no significant differences in perioperative complications.…”

Section: Data Selectionmentioning

confidence: 99%

Locally Advanced Gastric Cancer Management: A Cost-Effectiveness Analysis

Prasath,

Quinn,

Arjani

et al. 2024

The American Surgeon™

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Across the nation, patients with locally advanced gastric cancer (LAGC) are managed with modalities including upfront surgery (US) and perioperative chemotherapy (PCT). Preoperative therapies have demonstrated survival benefits over US and thus long-term outcomes are expected to vary between the options. However, as these 2 modalities continue to be regularly employed, we sought to perform a decision analysis comparing the costs and quality-of-life associated with the treatment of patients with LAGC to identify the most cost-effective option. We designed a decision tree model to investigate the survival and costs associated with the most commonly utilized management modalities for LAGC in the United States: US and PCT. The tree described costs and treatment strategies over a 6-month time horizon. Costs were derived from 2022 Medicare reimbursement rates using the third-party payer perspective for physicians and hospitals. Effectiveness was represented using quality-adjusted life-years (QALYs). One-way, two-way, and probabilistic sensitivity analyses were utilized to test the robustness of our findings. PCT was the most cost-effective treatment modality for patients with LAGC over US with a cost of $40,792.16 yielding 3.11 QALYs. US has a cost of $55,575.57 while yielding 3.15 QALYs; the incremental cost-effectiveness ratio (ICER) was $369,585.25. One-way and two-way sensitivity analyses favored PCT in all variations of variables across their standard deviations. Across 100,000 Monte Carlo simulations, 100% of trials favored PCT. In our model simulating patients with LAGC, the most cost-effective treatment strategy was PCT. While US demonstrated improved QALYs over PCT, the associated cost was too great to justify its use.

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Squamous cell carcinoma in solid organ transplant recipients: Review of the literature

Oteiza Rius,

Morelló Vicente,

Aguado Gil

2024

Medicina Clínica (English Edition)

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Sentinel lymph node biopsy for head and neck cutaneous squamous cell carcinoma using the Brigham and Women’s staging system: a cost analysis

Cited by 4 publications

References 30 publications

Incorporation of the 40-Gene Expression Profile (40-GEP) Test to Improve Treatment Decisions in High-Risk Cutaneous Squamous Cell Carcinoma (cSCC) Patients: Case Series and Algorithm

Incorporation of the 40-Gene Expression Profile (40-GEP) Test to Improve Treatment Decisions in High-Risk Cutaneous Squamous Cell Carcinoma (cSCC) Patients: Case Series and Algorithm

Locally Advanced Gastric Cancer Management: A Cost-Effectiveness Analysis

Squamous cell carcinoma in solid organ transplant recipients: Review of the literature

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