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Chen L, Zhou B, Tang M, Yao Y, Zhao Y, Hu Y, Lin Y, Ji J, Jiao Q. Aberrant expression of B7-H4 and B7-H5 contributes to the development of cutaneous squamous cell carcinoma. Arch Dermatol Res 2024; 316:382. [PMID: 38850312 PMCID: PMC11162363 DOI: 10.1007/s00403-024-03095-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/03/2023] [Accepted: 04/26/2024] [Indexed: 06/10/2024]
Abstract
Cutaneous squamous cell carcinoma (CSCC) is the second most common malignant tumor of the skin. B7 homolog 4 (B7-H4) and B7-H5 (B7 homolog 5) are associated with a variety of tumors. Investigate the potential role of B7-H4 and B7-H5 in regulating the tumorigenesis and progression of CSCC. B7-H4 and B7-H5 transcriptome data were collected from GEO and TCGA databases and subjected to bioinformatical analysis by protein-protein interaction (PPI) network, functional enrichment analysis, immune analysis, and drug-gene interaction prediction analysis. We characterized the expression of B7-H4 and B7-H5 in carcinoma tissues of CSCC patients by immunohistochemistry. Meanwhile, the clinical correlation of B7-H4 and B7-H5 in CSCC was explored by statistical analysis. B7-H4 and B7-H5 genes were under-expressed in CSCC and correlated with tumor staging. According to GO and KEGG Pathway enrichment analysis, B7-H4, and B7-H5 can regulate the proliferation and activation of T cells, lymphocytes, and monocytes, and the expression of cytokines, such as IL-6 and IL-10, in CSCC. B7-H4 and B7-H5 are also jointly involved in the occurrence and development of CSCC via the JAK-STAT and Notch signaling pathways. We found that B7-H4 and B7-H5 proteins were abnormally highly expressed in CSCC tissue and correlated with tumor size and stage. Our findings offer new insights into the pathogenesis of CSCC and suggest that B7-H4 and B7-H5 are novel tissue biomarkers and promising therapeutic targets for CSCC.
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Affiliation(s)
- Lu Chen
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Shizi Road 188, Suzhou, 215006, China
- Department of Dermatology, The Second Affiliated Hospital of Soochow University, Sangxiang Road 1055, Suzhou, 215004, China
| | - Bin Zhou
- Jiangsu Institute of Clinical Immunology and Jiangsu Key Laboratory of Clinical Immunology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Minhui Tang
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Shizi Road 188, Suzhou, 215006, China
| | - Yuxu Yao
- Department of Dermatology, The Second Affiliated Hospital of Soochow University, Sangxiang Road 1055, Suzhou, 215004, China
| | - Yue Zhao
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Shizi Road 188, Suzhou, 215006, China
| | - Ying Hu
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Shizi Road 188, Suzhou, 215006, China
| | - Yuxin Lin
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Shizi Road 188, Suzhou, 215006, China
- Center for Systems Biology, Department of Bioinformatics, School of Biology and Basic Medical Sciences, Soochow University, Suzhou, 215123, China
| | - Jiang Ji
- Department of Dermatology, The Second Affiliated Hospital of Soochow University, Sangxiang Road 1055, Suzhou, 215004, China.
| | - Qingqing Jiao
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Shizi Road 188, Suzhou, 215006, China.
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Lu H, Peng Z, Zheng Z, Li C, Wang Y, Liang L, Chen Y, Zeng K. Blocking the ATR-SerRS-VEGFA pathway targets angiogenesis for UV-induced cutaneous squamous cell carcinoma. Mol Carcinog 2024; 63:1160-1173. [PMID: 38695641 DOI: 10.1002/mc.23716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 05/16/2024]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most prevalent form of skin cancer, with an escalating incidence rate and a notable potential (up to 5%) for metastasis. Ultraviolet radiation (UVA and UVB) exposure is the primary risk factor for cSCC carcinogenesis, with literature suggesting ultraviolet radiation (UVR) promotes vascular endothelial growth factor A (VEGFA) expression. This study aims to investigate UVR-induced upregulation of VEGFA and explore combination therapeutic strategies. The skin squamous cell carcinoma cell line A431 was exposed to specific durations of ultraviolet radiation. The effect of emodin on ATR/SerRS/VEGFA pathway was observed. The cell masses were also transplanted subcutaneously into mice (n = 8). ATR inhibitor combined with emodin was used to observe the growth and angiogenesis of the xenografts. The results showed that UV treatment significantly enhanced the phosphorylation of SerRS and the expression level of VEGFA in A431 cells (p < 0.05). Treatment with emodin significantly inhibited this expression (p < 0.05), and the combination of emodin and ATR inhibitor further enhanced the inhibitory effect (p < 0.05). This phenomenon was further confirmed in the xenograft model, which showed that the combination of ATR inhibitor and emodin significantly inhibited the expression of VEGFA to inhibit angiogenesis (p < 0.05), thus showing an inhibitory effect on cSCC. This study innovatively reveals the molecular mechanism of UV-induced angiogenesis in cSCC and confirms SerRS as a novel target to inhibit cSCC angiogenesis and progression in vitro and in vivo studies.
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Affiliation(s)
- Hongyan Lu
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhangsong Peng
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhaohui Zheng
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Changxing Li
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Youyi Wang
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liuping Liang
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuxiang Chen
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kang Zeng
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Wu Z, Tao C, Yang L, Yan Y, Pan L, Zhang L. Treatment benefit of electrochemotherapy for superficial squamous cell carcinoma: a systematic review and single-arm meta-analysis. Clin Transl Oncol 2024:10.1007/s12094-024-03522-4. [PMID: 38758386 DOI: 10.1007/s12094-024-03522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE Treating aggressive superficial squamous cell carcinoma (SCC) poses challenges due to invasiveness. Palliative care is recommended for inoperable cases with extensive tumors near vital organs, risking disfigurement or functional impairment. Electrochemotherapy (ECT) is an emerging cutaneous tumor treatment, but its efficacy against superficial SCC remains uncertain. This study conducts a systematic review and single-arm meta-analysis to evaluate ECT's effectiveness against superficial SCC and provide current evidence for clinical practice. METHODS Embase, PubMed and Cochrane Library were searched for studies up to May 2023. The random effects model analyzed complete response (CR) and partial response (PR), with subgroup assessment based on drug dosage, treatment response evaluation, tumor size, primary/recurrent status, and tumor location. RESULTS Ten studies involving 162 patients and 208 tumors were included. Pooled CR and PR rates for ECT-treated superficial SCC were 66.5% (95% CI 48.4%-82.5%; I2 = 84%) and 20.3% (95% CI 10.5%-32.3%; I2 = 70%), respectively. Subgroup analysis indicated ECT's superiority in treating primary tumors (PR: 70%, CR: 30%) and tumors ≤ 3 cm (PR: 81.3%, CR: 10.1%) compared to recurrent tumors (PR: 56.7%, CR: 36.5%) and tumors > 3 cm (PR: 45.2%, CR: 34.4%). CONCLUSION This single-arm meta-analysis confirms ECT's efficacy against superficial SCC, especially in primary tumors and those ≤ 3 cm in diameter. The study highlights the impact of tumor location and response evaluation on ECT's benefits, warranting further investigation through additional research.
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Affiliation(s)
- Zhuoxia Wu
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Chen Tao
- School of Mathematics and Statistics, Northeast Normal University, Changchun, 130024, Jilin, China.
| | - Liehao Yang
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Yan Yan
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Lingfeng Pan
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Lianbo Zhang
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
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Wysong A, Somani AK, Ibrahim SF, Cañueto J, Fitzgerald AL, Siegel JJ, Prasai A, Goldberg MS, Farberg AS, Regula C, Bar A, Kasprzak J, Brodland DG, Koyfman SA, Arron ST. Integrating the 40-Gene Expression Profile (40-GEP) Test Improves Metastatic Risk-Stratification Within Clinically Relevant Subgroups of High-Risk Cutaneous Squamous Cell Carcinoma (cSCC) Patients. Dermatol Ther (Heidelb) 2024; 14:593-612. [PMID: 38424384 PMCID: PMC10965857 DOI: 10.1007/s13555-024-01111-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION The validated 40-gene expression profile (40-GEP) test independently stratifies risk of regional or distant metastasis for cutaneous squamous cell carcinoma (cSCC) tumors with high-risk clinicopathologic features. This study evaluated the stratification of risk by the 40-GEP test in a large cohort of tumors with one or more high-risk factors and in clinically relevant subgroups, including tumors within National Comprehensive Cancer Network (NCCN) high- and very-high-risk groups, lower-stage BWH T1 and T2a tumors, and patients > 65 years old. METHODS This multicenter (n = 58) performance study of the 40-GEP included 897 patients. Kaplan-Meier analyses were performed to assess risk stratification profiles for 40-GEP Class 1 (low), Class 2A (higher) and Class 2B (highest) risk groups, while nested Cox regression models were used to compare risk prediction of clinicopathologic risk classification systems versus risk classification systems in combination with 40-GEP. RESULTS Patients classified as 40-GEP Class 1, Class 2A, or Class 2B had significantly different metastatic risk profiles (p < 0.0001). Integrating 40-GEP results into models with individual clinicopathologic risk factors or risk classification systems (Brigham and Women's Hospital, American Joint Committee on Cancer Staging Manual, 8th Edition) and NCCN demonstrated significant improvement in accuracy for prediction of metastatic events (ANOVA for model deviance, p < 0.0001 for all models). CONCLUSION The 40-GEP test demonstrates accurate, independent, clinically actionable stratification of metastatic risk and improves predictive accuracy when integrated into risk classification systems. The improved accuracy of risk assessment when including tumor biology via the 40-GEP test ensures more risk-aligned, personalized patient management decisions.
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Affiliation(s)
- Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ally-Khan Somani
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA
- SkinMD, L.L.C., Orland Park, IL, USA
| | | | - Javier Cañueto
- Department of Dermatology Complejo, Asistencial Universitario de Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Instituto de Biología Celular y Molecular de Cáncer (CIC-IBMCC)-CSIC/USAL, Salamanca, Spain
| | | | - Jennifer J Siegel
- Research and Development, Castle Biosciences, Inc., Friendswood, TX, USA
| | - Anesh Prasai
- Research and Development, Castle Biosciences, Inc., Friendswood, TX, USA
| | - Matthew S Goldberg
- Research and Development, Castle Biosciences, Inc., Friendswood, TX, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Anna Bar
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Julia Kasprzak
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA
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Alda S, Ceausu RA, Gaje PN, Raica M, Cosoroaba RM. Mast Cell: A Mysterious Character in Skin Cancer. In Vivo 2024; 38:58-68. [PMID: 38148067 PMCID: PMC10756458 DOI: 10.21873/invivo.13410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 12/28/2023]
Abstract
Cutaneous malignancies represent a real concern and burden for the healthcare system, not only due to their increased frequency, but also due to the significant number of deaths attributed to these types of cancer. The genesis of tumors, their progression and metastasis are highly complex and researched subjects; apparently, mast cells (MCs) constitute an important piece in the complicated jigsaw puzzle of cancer. This article reviews the current knowledge of the roles MCs might play in the development of cutaneous malignancies. Besides their well-known and studied role in allergic reactions, MCs are linked to multiple and various disorders, including cancer. MCs exhibit incredible heterogeneity, being able to secrete numerous mediators that influence the tumor microenvironment and tumor cells. They are involved in many physiological and pathological processes, such as inflammation and angiogenesis. In this context, it is paramount to explore the advancements made so far in elucidating the roles that MCs have in skin cancer because they might provide valuable therapeutic targets in the future. Controversial and conflicting results were obtained across the studies examined.
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Affiliation(s)
- Silvia Alda
- Department of Microscopic Morphology/Histology, Angiogenesis Research Center Timişoara, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Raluca Amalia Ceausu
- Department of Microscopic Morphology/Histology, Angiogenesis Research Center Timişoara, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania;
| | - Pusa Nela Gaje
- Department of Microscopic Morphology/Histology, Angiogenesis Research Center Timişoara, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Marius Raica
- Department of Microscopic Morphology/Histology, Angiogenesis Research Center Timişoara, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Raluca Mioara Cosoroaba
- Department of Management, Legislation and Communication in Dental Medicine, First Department of Dentistry, Faculty of Dental Medicine, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
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Somani AK, Ibrahim SF, Tassavor M, Yoo J, Farberg AS. Use of the 40-gene Expression Profile (40-GEP) Test in Medicare-eligible Patients Diagnosed with Cutaneous Squamous Cell Carcinoma (cSCC) to Guide Adjuvant Radiation Therapy (ART) Decisions Leads to a Significant Reduction in Healthcare Costs. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2024; 17:41-44. [PMID: 38298751 PMCID: PMC10826833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Objective Adjuvant radiation therapy (ART) is often recommended for high-risk cSCC patients but carries significant costs and risks. This study aims to determine if utilizing the 40-GEP test to guide ART can reduce healthcare costs in cSCC management. Methods Medical claims data with new diagnoses of cSCC for the 12 months ending June 2022 in the Medicare (≥65 years) population (source: IQVIA claims database) were obtained and normalized to the general population for missingness. CPT codes associated with radiation therapy within one-year post diagnosis were used to establish adjuvant RT use (defined as 'ART'). Average weighted direct costs for four major ART modalities were calculated from published studies and (IQVIA). Sensitivity analysis was used to assess the financial impact of ART treatment using varying distributions of 40-GEP Class results. Results Normalized medical claims data identified 22,917 Medicare-eligible cSCC patients who received ART within the United States. The weighted average direct cost for ART, which includes the four most used CPT code-defined modalities (IGRT, IMRT, IMPT, and XRT), was $60,693 per patient, amounting to an annual projected ART cost of $1.4 billion. Using the distribution of 40-GEP results from published studies, utilization of a 40-GEP test result to avoid ART in these patients could save up to $972 million in Medicare-eligible population. Sensitivity analysis shows, depending upon the distribution of the 40-GEP results, that for every 10% of Class 2A test results omitting ART, an extra $38-66 million in annual savings is expected. Limitations Potential limitations include a need for more comprehensive patient information and the cost of ART-related complications. Conclusion Utilizing the 40-GEP test results to guide ART decision-making would result in material savings to Medicare.
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Affiliation(s)
- Ally-Khan Somani
- Dr. Somani is with the Department of Dermatology at Indiana's University School of Medicine in Indianapolis, Indiana
| | - Sherrif F Ibrahim
- Dr. Ibrahim is with Rochester Dermatologic Surgery in Victor, New York
| | - Michael Tassavor
- Dr. Tassavor is with Medical Dermatology and Cosmetic Surgery Centers in New York, New York
| | - Jane Yoo
- Dr. Yoo is with the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Aaron S Farberg
- Dr. Farberg is with Baylor Scott and White Health System in Dallas, Texas
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Tong JY, Huilgol SC, James C, Selva D. Recommendations for risk stratification of periocular squamous cell carcinoma. Surv Ophthalmol 2023; 68:964-976. [PMID: 37172747 DOI: 10.1016/j.survophthal.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
Periocular squamous cell carcinoma is a common cutaneous malignancy with generally favorable outcomes; however, the periocular region is intrinsically a high-risk location, and there exist a subset of lesions with a propensity for poor outcomes. Orbital invasion, intracranial perineural spread, nodal and distant metastasis are feared complications. There are several staging systems for eyelid carcinoma and cutaneous squamous cell carcinoma, but the definition of high-risk lesions remains heterogeneous. It is unclear exactly which lesions can be safely deescalated, and which require nodal evaluation and adjuvant multimodal therapy. We seek to answer these questions by summarizing the literature on clinicopathologic variables, molecular markers, and gene profiling tests in periocular squamous cell carcinoma, with the extrapolation of data from the cutaneous squamous cell carcinoma literature. Standardized pathology reports with information on tumor dimensions, histological subtype and grade, perineural invasion, and lymphovascular invasion should become uniform. Integration with gene expression profiling assessments will individualize and improve the predictive accuracy of risk stratification tools to ultimately inform multidisciplinary decision-making.
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Affiliation(s)
- Jessica Y Tong
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia; Save Sight Institute, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Shyamala C Huilgol
- Adelaide Skin & Eye Centre, South Australia, Australia; Department of Dermatology, Royal Adelaide Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Craig James
- Clinpath Laboratories, Adelaide, South Australia, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia; Adelaide Skin & Eye Centre, South Australia, Australia
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Pandeya N, Isbel N, Campbell S, Chambers DC, Hopkins P, Soyer HP, Jiyad Z, Plasmeijer EI, Whiteman DC, Olsen CM, Green AC. High-risk Prognostic Tumor Features of Squamous Cell Carcinomas in Organ Transplant Recipients Compared With the General Population. JAMA Dermatol 2023; 159:854-858. [PMID: 37314794 PMCID: PMC10267841 DOI: 10.1001/jamadermatol.2023.1574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/21/2023] [Indexed: 06/15/2023]
Abstract
Importance The extent to which major high-risk features of squamous cell carcinomas (SCCs) in organ transplant recipients (OTRs) differ from SCCs in the general population is not known. Objective To quantify the relative frequency of perineural invasion, invasion below the dermis, lack of cellular differentiation, and tumor diameter greater than 20 mm in SCCs in OTRs and the general population, by anatomic site. Design, Setting, and Participants This dual-cohort study in Queensland, Australia, included a cohort of OTRs at high risk of skin cancer ascertained from 2012 to 2015 (Skin Tumours in Allograft Recipients [STAR] study) and a population-based cohort ascertained from 2011 (QSkin Sun and Health Study). The STAR study comprised population-based lung transplant recipients and kidney and liver transplant recipients at high risk of skin cancer recruited from tertiary centers and diagnosed with histopathologically confirmed SCC from 2012 to 2015. The QSkin participants were recruited from Queensland's general adult population, and primary SCCs diagnosed from 2012 to 2015 were ascertained through Medicare (national health insurance scheme) and linked with histopathology records. Data analysis was performed from July 2022 to April 2023. Main Outcomes and Measures Prevalence ratio (PR) of head/neck location, perineural invasion, tumor invasion to/beyond subcutaneous fat, poor cellular differentiation, and tumor diameter greater than 20 mm among SCCs in OTRs vs the general population. Results There were 741 SCCs excised from 191 OTRs (median [IQR] age, 62.7 [56.7-67.1] years; 149 [78.0%] male) and 2558 SCCs from 1507 persons in the general population (median [IQR] age, 63.7 [58.0-68.8] years; 955 [63.4%] male). The SCCs developed most frequently on the head/neck in OTRs (285, 38.6%), but on arms/hands in the general population (896, 35.2%) (P < .001). After adjusting for age and sex, perineural invasion was more than twice as common in OTRs as in population cases (PR, 2.37; 95% CI, 1.70-3.30), as was invasion to/beyond subcutaneous fat (PR, 2.37; 95% CI, 1.78-3.14). Poorly vs well-differentiated SCCs were more than 3-fold more common in OTRs (PR, 3.45; 95% CI, 2.53-4.71), and prevalence of tumors greater than 20 mm vs 20 mm or smaller was moderately higher in OTRs (PR, 1.52; 95% CI, 1.08-2.12). Conclusions and Relevance In this dual-cohort study, SCCs in OTRs had significantly worse prognostic features than SCCs in the general population, reinforcing the necessity of early diagnosis and definitive management of SCCs in OTRs.
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Affiliation(s)
- Nirmala Pandeya
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Nicole Isbel
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Scott Campbell
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Daniel C. Chambers
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter Hopkins
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - H. Peter Soyer
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Zainab Jiyad
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Department of Dermatology, St George’s Hospital, London, United Kingdom
| | - Elsemieke I. Plasmeijer
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - David C. Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Catherine M. Olsen
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Adele C. Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- CRUK Manchester Institute and Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
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Masarwy R, Shilo S, Carmel Neiderman NN, Kampel L, Horowitz G, Muhanna N, Mansour J. The Prognostic Value and Clinical Utility of the 40-Gene Expression Profile (40-GEP) Test in Cutaneous Squamous Cell Carcinoma: Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15092456. [PMID: 37173922 PMCID: PMC10177351 DOI: 10.3390/cancers15092456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The current tumor staging systems for cutaneous squamous cell carcinoma (cSCC) are considered inadequate and insufficient for evaluating the risk of metastasis and for identifying patients at high risk of cSCC. This meta-analysis aimed to assess the prognostic significance of a 40-gene expression profile (40-GEP) both independently and integrated with clinicopathologic risk factors and established staging systems (American Joint Committee on Cancer, eighth edition (AJCC8) and Brigham and Women's Hospital (BWH)). METHODS Electronic databases, including PubMed (MEDLINE), Embase, the Cochrane Library, and Google Scholar, were systematically searched to identify cohort studies and randomized controlled trials on evaluations of the prediction value of 40-GEP in cSCC patients up to January 2023. The metastatic risk analysis of a given 40-GEP class combined with tumor stage and/or other clinicopathologic risk factors was based upon log hazard ratios (HRs) and their standard error (SE). Heterogeneity and subgroup analyses were performed, and data quality was assessed. RESULTS A total of 1019 patients from three cohort studies were included in this meta-analysis. The overall three-year metastatic-free survival rates were 92.4%, 78.9%, and 45.4% for class 1 (low risk), class 2A (Intermediate risk), and class 2B (high risk) 40-GEP, respectively, indicating a significant variation in survival rates between the risk classification groups. The pooled positive predictive value was significantly higher in class 2B when compared to AJCC8 or BWH. The subgroup analyses demonstrated significant superiority of integrating 40-GEP with clinicopathologic risk factors or AJCC8/BWH, especially for class 2B patients. CONCLUSIONS The integration of 40-GEP with staging systems can improve the identification of cSCC patients at high risk of metastasis, potentially leading to improved care and outcomes, especially in the high-risk class 2B group.
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Affiliation(s)
- Razan Masarwy
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shahaf Shilo
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Narin Nard Carmel Neiderman
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Liyona Kampel
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gilad Horowitz
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nidal Muhanna
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Jobran Mansour
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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10
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Singh G, Tolkachjov SN, Farberg AS. Incorporation of the 40-Gene Expression Profile (40-GEP) Test to Improve Treatment Decisions in High-Risk Cutaneous Squamous Cell Carcinoma (cSCC) Patients: Case Series and Algorithm. Clin Cosmet Investig Dermatol 2023; 16:925-935. [PMID: 37051586 PMCID: PMC10083143 DOI: 10.2147/ccid.s403330] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/25/2023] [Indexed: 04/08/2023]
Abstract
Cutaneous squamous cell carcinoma (cSCC) has become a significant public health issue due to its rapidly rising incidence and an estimated 1.8 million newly diagnosed cases annually. As with other cancers, treatment decisions for patients with cSCC are based primarily on a patient's risk for poor outcomes. There has been improvement in clinicopathologic factor-based risk assessment approaches, either through informal methods or ever evolving staging approaches. However, these approaches misidentify patients who will eventually have disease progression as low-risk and conversely, over classify patients as high-risk who do not experience relapse. To improve the accuracy of risk assessment for patients with cSCC, the 40-gene expression profile (40-GEP) test has been validated to show statistically significant stratification of a high-risk cSCC patient's risk of nodal or distant metastasis, independent of currently available risk-assessment methods. The 40-GEP test allows for a more accurate classification of metastatic risk for high-risk cSCC patients, with the aim to influence appropriate allocation of clinician time and therapeutic resources to those patients who will most benefit. The objective of this article is to present a treatment algorithm in which clinicians can easily integrate the results of the 40-GEP test into their current treatment approaches to tailor patient care based on individual tumor biology. The following modalities were considered: surveillance imaging, sentinel lymph node biopsy (SLNB), adjuvant radiation therapy (ART), and clinical follow-up. The authors have contributed their own cases for discussion as to how they have seen the beneficial impact of 40-GEP test results in their own practice. Overall, clinicians can identify risk-aligned treatment pathway improvements with the use of the 40-GEP test for challenging to manage, high-risk cSCC patients.
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Affiliation(s)
| | - Stanislav N Tolkachjov
- Epiphany Dermatology, Dallas, TX, USA
- University of Texas at Southwestern, Dallas, TX, USA
- Baylor University Medical Center, Dallas, TX, USA
- Texas A&M College of Medicine, Dallas, TX, USA
| | - Aaron S Farberg
- Texas A&M College of Medicine, Dallas, TX, USA
- Bare Dermatology, Dallas, TX, USA
- Baylor Scott & White Health System, Dallas, TX, USA
- Correspondence: Aaron S Farberg, Bare Dermatology, 2110 Research Row, Dallas, TX, 75235, USA, Tel +1 847-721-2725, Email
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11
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Muacevic A, Adler JR, Calame A. Cutaneous Squamous Cell Carcinoma Masquerading as a Verruca: Case Report and Literature Review of Coexisting Wart and Invasive Squamous Cell Carcinoma on the Hand. Cureus 2022; 14:e32408. [PMID: 36636549 PMCID: PMC9831616 DOI: 10.7759/cureus.32408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
A verruca is a human papillomavirus-associated infection of the mucosal or cutaneous epithelium. Cutaneous squamous cell carcinoma is an invasive skin cancer that commonly occurs on sun-exposed locations. Human papillomavirus infection has also been demonstrated to be a cocarcinogen, along with ultraviolet radiation, in the pathogenesis of cutaneous squamous cell carcinoma. A 63-year-old man presented with a verrucous nodule of nine months duration on his dorsal left hand. The clinical differential diagnosis included a wart and a small punch biopsy of the lesion showed a verruca. The lesion continued to enlarge and the possibility of a squamous cell carcinoma was considered. A second larger shave biopsy of the residual lesion was performed and the microscopic evaluation revealed not only a benign verruca at the lateral portion of the nodule but also an invasive squamous cell carcinoma in the center of the lesion. We hypothesize that the patient's human papillomavirus-associated wart may have contributed to the development of his cutaneous squamous cell carcinoma. Therefore, in an individual with a clinically suspected or biopsy-confirmed wart that persists despite lesion-directed treatment, additional evaluation of the lesion should be considered to assess whether an alternative or concurrent tumor, such as a cutaneous squamous cell carcinoma, is present.
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12
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LeQuang JA. Using Gene Expression Profiling to Personalize Skin Cancer Management. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:S3-S15. [PMID: 36405422 PMCID: PMC9664966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Risk-stratification of cancer, traditionally performed through staging, directs optimal disease management decisions with the result of improved patient outcomes. Many forms of cutaneous cancer have overall excellent survival rates, but conventional staging methods are imperfect in identifying high-risk patients. Gene expression profiling (GEP) is a clinically available, objective metric that can be used in conjunction with traditional clinicopathological staging to help clinicians stratify risk in patients with skin cancer, even in those who lack traditional risk markers. For patients with melanoma, the 31-GEP test provides personalized prognostic information that can guide risk-appropriate clinical management and surveillance decisions. The i31-GEP integrates 31-GEP results with clinicopathological features to provide a risk of recurrence (i31-GEP for ROR) and likelihood of having a positive sentinel lymph node biopsy (SLNB) (i31-GEP for SLNB) for patients with melanoma. For patients with cutaneous squamous cell carcinoma who have at least one risk factor, the 40-GEP test allows for better risk stratification by identifying the high-risk patients who are most likely to develop metastasis. These tests can be easily integrated into clinical practice to help guide treatment choices.
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Affiliation(s)
- Jo Ann LeQuang
- Ms. LeQuang is Owner of LeQ Medical in Angleton, Texas; Director of Scientific Communications at NEMA Research, Inc., in Naples, Florida; and Founding Director of No Baby Blisters in Colorado Springs, Colorado
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13
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Kitrell BM, Blue ED, Siller A, Lobl MB, Evans TD, Whitley MJ, Wysong A. Gene Expression Profiles in Cutaneous Oncology. Dermatol Clin 2022; 41:89-99. [DOI: 10.1016/j.det.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cohen PR, Kurzrock R. Dermatologic Disease-Directed Targeted Therapy (D 3T 2): The Application of Biomarker-Based Precision Medicine for the Personalized Treatment of Skin Conditions-Precision Dermatology. Dermatol Ther (Heidelb) 2022; 12:2249-2271. [PMID: 36121579 PMCID: PMC9515268 DOI: 10.1007/s13555-022-00801-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/23/2022] [Indexed: 11/03/2022] Open
Abstract
Precision dermatology uses individualized dermatologic disease-directed targeted therapy (D3T2) for the management of dermatoses and for the evaluation and therapy of cutaneous malignancies. Personalized/precision strategies are based on biomarkers that are most frequently derived from tissue transcriptomic expression or genomic sequencing or from circulating cytokines. For instance, the pathologic diagnosis of a pigmented lesion and determining the prognosis of a malignant melanocytic neoplasm can be enhanced by genomic/transcriptomic analysis. In addition to biopsy, innovative techniques have been developed for obtaining transcriptomes in skin conditions; as an example, patches can be applied to a psoriasis plaque for a few minutes to capture the epidermis/upper dermis transcriptome. Atopic dermatitis and prurigo nodularis may also be candidate conditions for precision dermatology. Precision dermatology has a role in managing melanoma and nonmelanoma skin cancers and rare cutaneous tumors-such as perivascular epithelioid cell tumor (PEComa)-that can originate in or metastasize to the skin. For instance, advanced/metastatic basal cell carcinomas can be treated with Hedgehog inhibitors (vismodegib and sonidegib) targeting the smoothened (SMO) or patched 1 (PTCH1) gene alterations that are a hallmark of these cancers and activate the Hedgehog pathway. Advanced/metastatic basal and cutaneous squamous cell cancers often have a high tumor mutational burden (which predicts immunotherapy response); immune checkpoint blockade with cemiplimab, a programmed cell death protein 1 (PD1) inhibitor, is now approved for these malignancies. Gene expression profiling of primary cutaneous squamous cell carcinoma can identify those individuals at high risk for subsequent metastases. In the realm of rare neoplasms, PEComas-which can originate in the skin, albeit uncommonly-have tuberous sclerosis complex 1 (TSC1)/tuberous sclerosis complex 2 (TSC2) gene alterations, which activate mammalian target of rapamycin (mTOR) signaling, and can be suppressed by nab-sirolimus, now approved for this condition. In summary, precision dermatologic techniques/strategies are an important emerging approach for evaluation and management of skin disorders and cutaneous neoplasms, and may serve as a paradigm for the application of precision medicine beyond dermatology.
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Affiliation(s)
- Philip R Cohen
- Department of Dermatology, Davis Medical Center, University of California, Sacramento, CA, USA. .,Touro University California College of Osteopathic Medicine, Vallejo, CA, USA. .,University of California, 10991 Twinleaf Court, San Diego, CA, 92131, USA.
| | - Razelle Kurzrock
- Department of Medicine, Medical College of Wisconsin Cancer Center and Genome Sciences and Precision Medicine Center, Milwaukee, WI, USA.,Worldwide Innovative Network (WIN) for Personalized Cancer Therapy, Villejuif, France
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