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Tumor characteristics predict skin cancer aggressiveness among organ transplant recipients
Researchers identified tumor location, differentiation, diameter, depth and perineural invasion as key risk factors for aggressive squamous cell carcinoma among solid organ transplant recipients, according to findings from a retrospective case series study published in JAMA Dermatology.
“Although most squamous cell carcinomas (SCCs) will be successfully treated, some show a very aggressive clinical course,” researcher Joana Lanz, MD, of the department of dermatology at University Hospital Zurich, and colleagues wrote. “Currently, the distinction between the many SCCs cured without sequelae and the few SCCs with an aggressive course can be hard to make at diagnosis.”
SCC incidence is 65-fold to 250-fold higher among solid organ transplant recipients than those who have not received transplants, according to study background.
Lanz and colleagues used data from five centers within the Skin Care in Organ Transplant Patients, Europe Network, to analyze clinical and histological characteristics of 51 solid organ transplant recipients (men, n = 43; median age at transplantation, 51 years; range, 19-71) who were discovered to have aggressive SCC (median age at diagnosis, 62 years; range 36-77). Most of the patients (78%) had received a kidney.
Researchers defined aggressive SCC as nodal or distant metastasis or death due to local progression of primary SCC.
The most common primary SCC sites included the face (67%; n = 34), scalp (12%; n = 6) and upper extremities (12%; n = 6).
Twenty-one of the tumors (41%) had poor differentiation, with a median tumor diameter of 18 mm (range, 4-64) and median tumor depth of 6.2 mm (range, 1-20). Twenty patients (39%) had perineural invasion, had 23 (45%) had a local recurrence.
Kaplan-Meier analysis revealed OS reached 50% at 28 months (95% CI, 21.3-34.7). Twenty-three percent of patients (± 6.4%) achieved 5-year OS and 11.3% (± 5.5%) achieved 10-year OS.
Researchers reported 50% disease-specific survival at 33 months (95% CI, 0.9-45.1), falling to 30.5% (± 7.6%) at 5 years and 25.9% (± 7.1%) at 10 years.
Mean 5-year and 10-year PFS were both 5% (± 1.3%).
Median time from metastasis to death was 12 months (95% CI, 3.8-20.2.). Almost all SCCs progressed within 2 years of diagnosis.
Limitations of the study included its retrospective design, limited number of patients and contributing centers, and lack of a control group. – by Jennifer Byrne
Disclosures : The researchers report no relevant financial disclosures.