Factors predictive of recurrence and death from cutaneous squamous cell carcinoma

A 10-year, single-institution cohort study

Chrysalyne D. Schmults, Pritesh S. Karia, Joi B. Carter, Jiali Han, Abrar A. Qureshi

Research output: Contribution to journalArticle

137 Citations (Scopus)

Abstract

Importance: Although most cases of cutaneous squamous cell carcinoma (CSCC) are easily cured with surgery or ablation, a subset of these tumors recur, metastasize, and cause death. We conducted the largest study of CSCC outcomes since 1968. Objective: To identify risk factors independently associated with poor outcomes in primary CSCC. Design: A 10-year retrospective cohort study. Setting: An academic hospital in Boston. Participants: Nine hundred eighty-five patients with 1832 tumors. Main Outcomes and Measures: Subhazard ratios for local recurrence, nodal metastasis, disease-specific death, and all-cause death adjusted for presence of known prognostic risk factors. Results: The median follow-up was 50 (range, 2-142) months. Local recurrence occurred in 45 patients (4.6%) during the study period; 36 (3.7%) developed nodal metastases; and 21 (2.1%) died of CSCC. In multivariate competing risk analyses, independent predictors for nodal metastasis and disease-specific death were a tumor diameter of at least 2 cm (subhazard ratios, 7.0 [95% CI, 2.2-21.6] and 15.9 [4.8-52.3], respectively), poor differentiation (6.1 [2.5-14.9] and 6.7 [2.7-16.5], respectively), invasion beyond fat (9.3 [2.8-31.1] and 13.0 [4.3-40.0], respectively), and ear or temple location (3.8 [1.1-13.4] and 5.9 [1.3-26.7], respectively). Perineural invasion was also associated with disease-specific death (subhazard ratio, 3.6 [95% CI, 1.1-12.0]), as was anogenital location, but few cases were anogenital. Overall death was associated with poor differentiation (subhazard ratio, 1.3 [95% CI, 1.1-1.6]) and invasion beyond fat (1.7 [1.1-2.8]). Conclusions and Relevance: Cutaneous squamous cell carcinoma carries a low but significant risk of metastasis and death. In this study, patients with CSCC had a 3.7% risk of metastasis and 2.1% risk of disease-specific death. Tumor diameter of at least 2 cm, invasion beyond fat, poor differentiation, perineural invasion, and ear, temple, or anogenital location were risk factors associated with poor outcomes. Accurate risk estimation of outcomes from population-based data and clinical trials proving the utility of disease-staging modalities and adjuvant therapy is needed.

Original languageEnglish (US)
Pages (from-to)541-547
Number of pages7
JournalJAMA Dermatology
Volume149
Issue number5
DOIs
StatePublished - May 1 2013
Externally publishedYes

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antineoplaston A10
Squamous Cell Carcinoma
Cohort Studies
Recurrence
Skin
Neoplasm Metastasis
Fats
Ear
Cause of Death
Neoplasms
Retrospective Studies
Outcome Assessment (Health Care)
Clinical Trials
Population

ASJC Scopus subject areas

  • Dermatology

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Factors predictive of recurrence and death from cutaneous squamous cell carcinoma : A 10-year, single-institution cohort study. / Schmults, Chrysalyne D.; Karia, Pritesh S.; Carter, Joi B.; Han, Jiali; Qureshi, Abrar A.

In: JAMA Dermatology, Vol. 149, No. 5, 01.05.2013, p. 541-547.

Research output: Contribution to journalArticle

Schmults, Chrysalyne D. ; Karia, Pritesh S. ; Carter, Joi B. ; Han, Jiali ; Qureshi, Abrar A. / Factors predictive of recurrence and death from cutaneous squamous cell carcinoma : A 10-year, single-institution cohort study. In: JAMA Dermatology. 2013 ; Vol. 149, No. 5. pp. 541-547.
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abstract = "Importance: Although most cases of cutaneous squamous cell carcinoma (CSCC) are easily cured with surgery or ablation, a subset of these tumors recur, metastasize, and cause death. We conducted the largest study of CSCC outcomes since 1968. Objective: To identify risk factors independently associated with poor outcomes in primary CSCC. Design: A 10-year retrospective cohort study. Setting: An academic hospital in Boston. Participants: Nine hundred eighty-five patients with 1832 tumors. Main Outcomes and Measures: Subhazard ratios for local recurrence, nodal metastasis, disease-specific death, and all-cause death adjusted for presence of known prognostic risk factors. Results: The median follow-up was 50 (range, 2-142) months. Local recurrence occurred in 45 patients (4.6{\%}) during the study period; 36 (3.7{\%}) developed nodal metastases; and 21 (2.1{\%}) died of CSCC. In multivariate competing risk analyses, independent predictors for nodal metastasis and disease-specific death were a tumor diameter of at least 2 cm (subhazard ratios, 7.0 [95{\%} CI, 2.2-21.6] and 15.9 [4.8-52.3], respectively), poor differentiation (6.1 [2.5-14.9] and 6.7 [2.7-16.5], respectively), invasion beyond fat (9.3 [2.8-31.1] and 13.0 [4.3-40.0], respectively), and ear or temple location (3.8 [1.1-13.4] and 5.9 [1.3-26.7], respectively). Perineural invasion was also associated with disease-specific death (subhazard ratio, 3.6 [95{\%} CI, 1.1-12.0]), as was anogenital location, but few cases were anogenital. Overall death was associated with poor differentiation (subhazard ratio, 1.3 [95{\%} CI, 1.1-1.6]) and invasion beyond fat (1.7 [1.1-2.8]). Conclusions and Relevance: Cutaneous squamous cell carcinoma carries a low but significant risk of metastasis and death. In this study, patients with CSCC had a 3.7{\%} risk of metastasis and 2.1{\%} risk of disease-specific death. Tumor diameter of at least 2 cm, invasion beyond fat, poor differentiation, perineural invasion, and ear, temple, or anogenital location were risk factors associated with poor outcomes. Accurate risk estimation of outcomes from population-based data and clinical trials proving the utility of disease-staging modalities and adjuvant therapy is needed.",
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T2 - A 10-year, single-institution cohort study

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AU - Carter, Joi B.

AU - Han, Jiali

AU - Qureshi, Abrar A.

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N2 - Importance: Although most cases of cutaneous squamous cell carcinoma (CSCC) are easily cured with surgery or ablation, a subset of these tumors recur, metastasize, and cause death. We conducted the largest study of CSCC outcomes since 1968. Objective: To identify risk factors independently associated with poor outcomes in primary CSCC. Design: A 10-year retrospective cohort study. Setting: An academic hospital in Boston. Participants: Nine hundred eighty-five patients with 1832 tumors. Main Outcomes and Measures: Subhazard ratios for local recurrence, nodal metastasis, disease-specific death, and all-cause death adjusted for presence of known prognostic risk factors. Results: The median follow-up was 50 (range, 2-142) months. Local recurrence occurred in 45 patients (4.6%) during the study period; 36 (3.7%) developed nodal metastases; and 21 (2.1%) died of CSCC. In multivariate competing risk analyses, independent predictors for nodal metastasis and disease-specific death were a tumor diameter of at least 2 cm (subhazard ratios, 7.0 [95% CI, 2.2-21.6] and 15.9 [4.8-52.3], respectively), poor differentiation (6.1 [2.5-14.9] and 6.7 [2.7-16.5], respectively), invasion beyond fat (9.3 [2.8-31.1] and 13.0 [4.3-40.0], respectively), and ear or temple location (3.8 [1.1-13.4] and 5.9 [1.3-26.7], respectively). Perineural invasion was also associated with disease-specific death (subhazard ratio, 3.6 [95% CI, 1.1-12.0]), as was anogenital location, but few cases were anogenital. Overall death was associated with poor differentiation (subhazard ratio, 1.3 [95% CI, 1.1-1.6]) and invasion beyond fat (1.7 [1.1-2.8]). Conclusions and Relevance: Cutaneous squamous cell carcinoma carries a low but significant risk of metastasis and death. In this study, patients with CSCC had a 3.7% risk of metastasis and 2.1% risk of disease-specific death. Tumor diameter of at least 2 cm, invasion beyond fat, poor differentiation, perineural invasion, and ear, temple, or anogenital location were risk factors associated with poor outcomes. Accurate risk estimation of outcomes from population-based data and clinical trials proving the utility of disease-staging modalities and adjuvant therapy is needed.

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