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Patients with invasive CSCC displayed risk factors for metastasis, death
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Patients with invasive cutaneous squamous cell carcinoma had a low but significant risk for metastasis and death, with risk factors including tumor diameter, deep invasion, poor cellular differentiation and perineural invasion, according to study results.
In a 10-year retrospective cohort study, researchers evaluated 985 patients (median age, 71 years; 52.7% men) with 1,832 cutaneous squamous cell carcinoma (CSCC) at a Boston academic hospital. Fifty months was the median follow-up.
Main outcomes and measures included subhazard ratios (SHR) for local recurrence, nodal metastasis and disease-specific and all-cause deaths adjusted for prognostic factors.
Forty-five patients (4.6%) experienced local recurrence. Nodal metastases occurred in 36 patients (3.7%); 21 patients (2.1%) died of CSCC. Using multivariate analysis, independent predictors for nodal metastasis and disease-specific death included tumor diameter of at least 2 cm (SHR=7; 95% CI, 2.2-21.6; SHR=15.9; 95% CI, 4.8-52.3, respectively), poor cellular differentiation (SHR=6.1; 95% CI, 2.5-14.9; SHR=6.7; 95% CI, 2.7-16.5,), invasion beyond fat (SHR=9.3; 95% CI, 2.8-31.1; SHR=13; 95% CI, 4.3-40), and ear or temple location (SHR=3.8; 95% CI, 1.1-13.4; SHR=5.9; 95% CI, 1.3-26.7).
Disease-specific death also was associated with perineural invasion (SHR=3.6; 95% CI, 1.1-12), along with anogenital location (SHR=23.7; 95% CI, 7.1-79.1). Poor differentiation (SHR=1.3; 95% CI, 1.1-1.6) and invasion beyond fat (SHR=1.7; 95% CI, 1.1-2.8) were associated with all-cause death.
“These five risk factors may be among the most significant drivers of CSCC outcomes, but further studies are needed to replicate our findings,” the researchers concluded. “Clinical trials regarding nodal staging and adjuvant therapy may be targeted at patients with one or more such risk factors.”
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