TY - JOUR
T1 - Immunosuppression is a risk factor for worse survival and disease-specific death in cutaneous squamous cell carcinoma
AU - Greene, Adina
AU - Hwang, Angelina S.
AU - Kechter, Jacob A.
AU - Boudreaux, Blake W.
AU - Bhullar, Puneet
AU - Severson, Kevin J.
AU - Butterfield, Richard J.
AU - Zhang, Nan
AU - Tolaymat, Leila M.
AU - Degesys, Catherine A.
AU - Ochoa, Shari A.
AU - Arpey, Christopher J.
AU - Baum, Christian
AU - Mangold, Aaron R.
N1 - Publisher Copyright:
© 2023 The Authors. JEADV Clinical Practice published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.
PY - 2024/3
Y1 - 2024/3
N2 - Background: Previous literature on cutaneous squamous cell carcinoma (cSCC) suggests that the incidence, rate of metastasis, and tumour severity of cSCC are higher in immunosuppressed patients than in immunocompetent patients. However, current literature lacks an extensive comparison of cSCC clinical characteristics and outcomes in immunosuppressed patients. Objectives: We compared cSCC tumour characteristics and disease-related outcomes to help guide the clinical management of immunosuppressed patients. Methods: We conducted a retrospective review of histopathologic and clinical data from 935 cSCC cases (19.5% immunosuppressed) from the Mayo Clinic. Results: Immunosuppression was associated with younger age (69.3 vs. 74.8 years old, p < 0.0001), male gender (78.6% vs. 67.2%, p = 0.003), and higher grade cSCC tumour characterized by moderate or poor differentiation (25.7% vs. 15.8%, p = 0.009; 9.2% vs. 7.2%, p = 0.009, respectively). No significant differences were found in other tumour characteristics, including clinical tumour dimension, Brigham and Women's Hospital tumour staging or cumulative risk of metastasis and recurrence. Immunosuppressed patients had an increased risk of disease-specific death on univariate analysis (hazard ratio [HR] [95% confidence interval, CI] 2.05 [1.13–3.74], p = 0.0128). Overall survival in the immunosuppressed population was worse (adjusted HR [95% CI] 1.83 [1.42–2.35], p < 0.001) and, notably, solid organ transplant recipients had the lowest overall survival when stratifying immunosuppressed patients by immunosuppression type (HR [95% CI] 1.62 [1.17–2.24], p < 0.0001). Conclusions: In our study, immunosuppression status was predictive of poor differentiation of tumours and a reduction in overall and cSCC-specific survival. Current staging systems for cSCC do not include immunosuppression as a risk factor and incorporating immune status may be beneficial for accurate risk stratification.
AB - Background: Previous literature on cutaneous squamous cell carcinoma (cSCC) suggests that the incidence, rate of metastasis, and tumour severity of cSCC are higher in immunosuppressed patients than in immunocompetent patients. However, current literature lacks an extensive comparison of cSCC clinical characteristics and outcomes in immunosuppressed patients. Objectives: We compared cSCC tumour characteristics and disease-related outcomes to help guide the clinical management of immunosuppressed patients. Methods: We conducted a retrospective review of histopathologic and clinical data from 935 cSCC cases (19.5% immunosuppressed) from the Mayo Clinic. Results: Immunosuppression was associated with younger age (69.3 vs. 74.8 years old, p < 0.0001), male gender (78.6% vs. 67.2%, p = 0.003), and higher grade cSCC tumour characterized by moderate or poor differentiation (25.7% vs. 15.8%, p = 0.009; 9.2% vs. 7.2%, p = 0.009, respectively). No significant differences were found in other tumour characteristics, including clinical tumour dimension, Brigham and Women's Hospital tumour staging or cumulative risk of metastasis and recurrence. Immunosuppressed patients had an increased risk of disease-specific death on univariate analysis (hazard ratio [HR] [95% confidence interval, CI] 2.05 [1.13–3.74], p = 0.0128). Overall survival in the immunosuppressed population was worse (adjusted HR [95% CI] 1.83 [1.42–2.35], p < 0.001) and, notably, solid organ transplant recipients had the lowest overall survival when stratifying immunosuppressed patients by immunosuppression type (HR [95% CI] 1.62 [1.17–2.24], p < 0.0001). Conclusions: In our study, immunosuppression status was predictive of poor differentiation of tumours and a reduction in overall and cSCC-specific survival. Current staging systems for cSCC do not include immunosuppression as a risk factor and incorporating immune status may be beneficial for accurate risk stratification.
KW - cutaneous squamous cell carcinoma
KW - immunosuppression
KW - solid organ transplant recipients
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U2 - 10.1002/jvc2.265
DO - 10.1002/jvc2.265
M3 - Article
AN - SCOPUS:85186439947
SN - 2768-6566
VL - 3
SP - 182
EP - 190
JO - JEADV Clinical Practice
JF - JEADV Clinical Practice
IS - 1
ER -