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Alternative tumor staging system improved prognostic results for CSCC

An alternative tumor staging system offered improved prognostic discrimination via stratification of stage T2 cutaneous squamous cell carcinoma, according to study results.

In a retrospective cohort study, researchers analyzed 256 cutaneous squamous cell carcinoma (CSCC) tumors in 237 patients (median age at diagnosis, 80; 77% men). Researchers sought to evaluate the 2010 American Joint Committee on Cancer (AJCC) tumor (T) staging system’s ability to stratify occurrence of poor outcomes in CSCC and to identify risk factors. A pathology and dermatopathology database search was conducted for patients diagnosed with high-risk CSCC.

Less than 2% of patients (4 cases) had AJCC tumor stages T3 or T4, which required bone invasion, making outcomes for AJCC stages T2 to T4 statistically indistinguishable. AJCC stage T2 cases had the poorest outcomes (83% of nodal metastases, 92% of death from CSCC). For improved stratification in this group, researchers developed an alternative tumor staging system.

“Four risk factors were found to be statistically independent prognostic factors for at least two outcomes of interest in multivariate modeling,” the researchers said. The factors included poor differentiation, perineural invasion, tumor diameter of 2 cm or more and invasion beyond subcutaneous fat.

The presence of no factors indicated T1, one factor indicated T2a, two or three factors, T2b; four factors or bone invasion, T3 (AJCC T3/T4 cases). All four factors were significantly different between stages T2a and T2b. Nineteen percent of the cohort had stage T2b tumors, yet they accounted for 72% of nodal metastases and 83% of CSCC-related deaths.

“The alternative tumor staging system herein may be useful in designing inclusion criteria for those contemplating clinical trials of patients with CSCC but requires further validation prior to widespread clinical use,” the researchers concluded. “Stage T2b tumors are responsible for most poor outcomes and may be a focus of a high-risk CSCC study.”

Disclosure: Rosalie Elenitsas, MD, reported receiving royalties from Lippincott Williams & Wilkins for editing and writing textbooks.