Immunosuppression not a risk factor for poor outcomes in cutaneous squamous cell carcinoma
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Immunosuppression is not an independent risk factor for poor outcomes in patients with cutaneous squamous cell carcinomas when adjusting for tumor stage, according to a study.
Immunosuppressed individuals face a greater risk of cutaneous squamous cell carcinoma (cSCC) compared with the general population, Daniel M. O’Connor, MD, micrographic surgeon at Dermatology and Skin Health, and colleagues wrote. However, few studies have considered tumor stage when examining cSCC outcomes in immunosuppressed patients.
“The study reinforces to clinicians that squamous cell carcinoma outcomes predicted by BWH and AJCC8 staging like metastasis and death don’t appear to be affected by immune status in patients with primary tumors,” O’Conner told Healio. “While immunosuppressed patients get more tumors, and worse tumors, our study suggests that primary tumor staging predicts the risk of poor outcomes, and can be used in clinical decision-making, largely irrespective of immune status.”
Using a large, dual center cohort of primary tumors, this retrospective study examined 989 primary tumors from 814 immunocompromised patients and 6,608 tumors from 4,198 immunocompetent patients. Immunocompromised vs. immunocompetent patients were younger (mean age at diagnosis, 73.8 vs. 68.4 years; P < .001) and a smaller proportion were women (36.4% vs. 47.1%; P < .001). In immunocompromised patients, the most common causes of immunosuppression included organ transplants (31.7%), immunosuppressive medications for inflammatory disease (30%) and chronic lymphocytic leukemia (13.9%). Poor outcomes were classified as disease-specific death or tumor metastasis. The researchers used Brigham and Women’s Hospital (BWH) and the American Joint Committee on Cancer, 8th Edition (AJCC8) tumor staging systems.
O’Conner and colleagues found that immunocompromised patients had 53.1% more high T-stage tumors compared with immunocompetent patients (BWH, 4.9% vs. 3.3%; AJCC8, 10.9% vs. 7%; both, P < .001). Immune status was not a significant predictor of poor outcomes (subhazard ratio [SHR] = 1.04; 95% CI, 0.69-1.6); however, significant predictors did include BWH tumor stage (SHR = 14.8 for high T-stage tumors; 95% CI, 8-27.6; P < .001) and male sex (SHR = 2.3; 95% CI, 1.4-3.8; P = .002).
“The study emphasizes the importance of early detection and definitive treatment for tumors,” O’Connor told Healio. “Other literature has shown immunosuppression appears to have a deleterious effect in more advanced disease, while ours implies that this isn’t the case if it’s caught and eradicated early. Therefore, meticulous eradication of the primary tumor is key.”