Survival of Patients with Cutaneous Squamous Cell Carcinoma: Results of a Prospective Cohort Study

Abstract

Cutaneous squamous cell carcinoma (cSCC) is an increasing health burden in white populations. We prospectively assessed risk factors for tumor-specific and overall survival in 1,434 patients who underwent surgery for cSCC between January 24, 2005, and May 29, 2015. A total of 2,149 invasive cSCCs were analyzed. Univariate and multivariate survival analyses included tumor thickness, horizontal size, body site, histological differentiation, desmoplastic growth, history of multiple cSCCs, and immunosuppression. The primary endpoint was time to tumor-specific death. During a median follow-up period of 36.5 months (range = 0-137 months), 515 patients died; 40 because of cSCC (2.8%). Of those, 12 died because of visceral metastases and 28 because of tumor growth by local infiltration. On multivariate analyses, prognostic factors for tumor-specific survival were increased vertical tumor thickness (hazard ratio = 6.73; 95% confidence interval = 3.47-13.08; P < 0.0001), desmoplastic growth (hazard ratio = 4.14; 95% confidence interval = 2.68-9.83; P < 0.0001), and immunosuppression (hazard ratio = 2.07; 95% confidence interval = 1.04-4.12; P = 0.039). Defining a point list out of those factors and grouping them into four cohorts resulted in comprehensively separating survival curves (P < 0.001). Using a cut-off for tumor thickness of 6 mm or greater, the presence of desmoplastic growth and immunosuppression identifies patients at high risk for tumor-specific death.

Systematic review of the prevalence of nodal metastases and the prognostic utility of sentinel lymph node biopsy in cutaneous squamous cell carcinoma

“…Exact Breslow depth was reported for 19 patients and the mean thickness was 10.2 mm (range, 2. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The information reported for the other variables was scarce.…”

“…2 Diverse clinical and pathological risk factors determining a worse prognosis have been identified in cSCC, and include tumor size and thickness, degree of differentiation, perineural invasion, invasion past subcutaneous tissue and a high-risk location. [3][4][5] cSCC with features related to worse outcomes is known as "high-risk" cSCC. It is more aggressive than other forms and is associated with a higher risk of metastasis and shorter survival.…”

Clinical features and outcome of dermal squamous cell carcinoma in 193 dogs (1987‐2017)

“…Standardized measurements for presence or absence of actinic histopathologic change, tissue invasion and mitotic index were not available in this population and this limitation may have provided over‐ or underestimates of prevalence or severity for the assessed histopathologic factors. However, a systematic approach to assessment of future biopsies with inclusion of depth of invasion in millimetres, tumour subtype, perineural invasion and Ki‐67 may help to discern whether these criteria are reflective of high risk tumours in dogs as has been documented in people . Tissue invasiveness was found to be associated with histopathologic features of actinic change, but this may have been biased because the actinic designation required a microscopic description whereas the tissue invasion was not uncommonly mentioned in the final diagnosis.…”

Correlation of focal adhesion kinase expression with nodal metastasis in patients with head and neck cutaneous squamous cell carcinoma

“…Patient age was defined as the age at the time of resection. Immunosuppressed patients included are chronic lymphatic leukemia, liver transplant, kidney transplant, heart transplant, diffuse large lymphoma B cell, and polycythemia vera treated with hydroxyurea …”

“…Given this low metastatic rate, most head and neck cSCC are not investigated or treated for occult metastases but rather treated based on positive clinical examination. Nevertheless, there are certain characteristics to a primary lesion that imply a higher risk of metastasis: primary lesion >2 cm in diameter; tumor thickness >6 mm; tumor on or around the ear; recurrent lesions; poorly differentiated grade; desmoplastic growth microvascular, lymphatic, or perineural invasion; advanced age; and a cSCC in an immunocompromised host . Even though the role of molecular factors in the lymphatic dissemination of cSCC has been studied; however, currently there are no clinically useful biomarkers of metastatic potential in primary cSCC .…”