Outcomes of patients with metastatic cutaneous squamous cell carcinoma to the axilla: a multicentre cohort study

Risk factors and novel predictive model for metastatic cutaneous squamous cell carcinoma: a population-based analysis

Cutaneous squamous cell carcinoma (cSCC) is one of the most common skin malignancies. Patients with metastatic cSCC (mcSCC) tended to have unfavorable prognosis. However, there is no available models to evaluate the survival outcomes for these patients. This study retrospectively collected mcSCC cases identified from The Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2018. All patients were randomly divided into the training and validation cohorts. The independent factors which predicted the cancer-specific survival (CSS) were identified by Cox proportional hazard regression analysis, and were used to build nomogram. he discrimination ability of nomograms was evaluated using the concordance index (C-index). The receiver operating characteristic (ROC) curve and the corresponding area under the curve (AUC) at 1, 3, and 5 years were calculated to estimate the predictive accuracy. The performance of this nomogram was evaluated by the calibration curves. The decision curve analyses (DCAs) were conducted to assess the clinical usefulness of the models. Based on the novel nomograms, all patients were classified into low- and high-risk groups. Kaplan-Meier curves were plotted to compare the survival outcomes of two groups. All analyses were conducted by R software (Version 4.1.3). A total of 916 patients were included. Age, marital status, location of the primary sites, number of metastases, T stage, N stage, surgical resection of the primary sites, radiotherapy of the primary sites, and chemotherapy were significantly associated with CSS. A nomogram predicting CSS was built based on these parameters. C-index and ROC curves of nomogram showed promising discriminating and predicting ability for CSS. Survival analysis showed that patients in the low-risk group had significant superior CSS time than those in the high-risk group (median CSS time: 15.0 vs. 5.0 months, p < 0.001). In conclusion, we developed and validated a novel nomogram predicting the CSS in metastatic cSCC patients. This nomogram could be used to assess the prognosis of metastatic cSCC patients, and help clinicians evaluating optimal treatment options for individual patient.

Oncological Outcome After Lymph Node Dissection for Cutaneous Squamous Cell Carcinoma

BACKGROUND

Although cutaneous squamous cell carcinoma (cSCC) is common, lymph node metastases are relatively rare and are usually treated with lymph node dissection (LND). The aim of this study was to describe the clinical course and prognosis after LND for cSCC at all anatomical locations.

METHODS

A retrospective search at three centres was performed to identify patients with lymph node metastases of cSCC who were treated with LND. Prognostic factors were identified by uni- and multivariable analysis.

RESULTS

A total of 268 patients were identified with a median age of 74. All lymph node metastases were treated with LND, and 65% of the patients received adjuvant radiotherapy. After LND, 35% developed recurrent disease both locoregionally and distantly. Patients with more than one positive lymph node had an increased risk for recurrent disease. 165 (62%) patients died during follow-up of whom 77 (29%) due to cSCC. The 5-year OS- and DSS rate were 36% and 52%, respectively. Disease-specific survival was significantly worse in immunosuppressed patients, patients with primary tumors >2cm and patients with more than one positive lymph node.

CONCLUSIONS

This study shows that LND for patients with lymph node metastases of cSCC leads to a 5-year DSS of 52%. After LND, approximately one-third of the patients develop recurrent disease (locoregional and/or distant), which underscores the need for better systemic treatment options for locally advanced cSCC. The size of the primary tumor, more than one positive lymph node, and immunosuppression are independent predictors for risk of recurrence and disease-specific survival after LND for cSCC.

Advanced or Metastatic Cutaneous Squamous Cell Carcinoma: The Current and Future Role of Radiation Therapy in the Era of Immunotherapy

Radiation therapy (RT) is an effective therapeutic option for small localized cutaneous squamous cell carcinoma (cSCC) among patients who are not eligible for or refuse surgery. RT also has a defined role as an adjuvant treatment in cases of adverse features that predispose to tumor recurrence after local excision. Since the development of cSCC is often a late consequence of chronic sun exposure, its occurrence is more common among elderly patients whose comorbidities may contraindicate surgical procedures. These could be impeded not only by frail medical conditions but also by technical issues. Indeed, an aggressive locoregional behavior of cSCC may culminate in unresectability due to widespread invasion of neighboring tissues. Moreover, cSCC could develop distant metastases. Both locally advanced and metastatic cSCCs carry a poor prognosis. In these scenarios, recent discoveries of tumor molecular targets are promoting the use of promising systemic therapies, especially immunotherapy, over RT. However, the results from using immunotherapy and, even more so, of chemotherapy are still not optimal. By contrast, advances in radiation delivery equipment can safely treat even large and complex-shaped cSCC targets in challenging body sites. In addition, RT could also have a role in metastatic cSCC settings by enhancing the effectiveness of concomitant immunotherapy. The aim of this review is to summarize and comment on the body of literature about the use of radiotherapy for operable and inoperable locally advanced cSCCs and for metastatic ones in an attempt to define its current and future role.

Cutaneous squamous cell carcinoma metastatic to the axilla and groin: Outcomes and prognostic factors

PURPOSE

This study examined the clinical outcomes and prognostic factors of patients with metastatic cutaneous SCC metastatic to the axilla and groin when managed with curative-intent lymphadenectomy and received (neo)adjuvant treatment.

METHODS AND MATERIALS

We conducted a single institution retrospective review. Patients who had nodal disease without distant spread were 18 years or older with no non-cutaneous primary identified.

RESULTS

From January 2000 to July 2015, 78 patients were treated for axilla (64, 82%) or inguinal (14, 18%) involvement with cSCC. The median age was 75.5 years (range: 29-95), and 8 patients (11%) were immunosuppressed. The median size of the largest node was 45 mm (range: 8-135), and extracapsular extension was found in 63 (81%) cases. A majority of patients were treated with surgery alone (21, 26.9%) and surgery with adjuvant radiation therapy (54, 69%). The 2-year OS and PFS were 50% (95% CI: 40%-63%) and 43% (95% CI: 33%-56%), and 5-year OS and PFS were 33% (95% CI:23%-47%) and 32% (95% CI:22%-46%) respectively in the entire cohort. On univariable analysis, factors associated with longer OS were as follows: younger age (HR 1.1, 95% CI: 0.9-1.3 P = 0.021), improved performance status (HR 1.5, 95% CI:1.0-2.3 P = 0.026), lack of immunosuppression (HR 3.3, 95% CI: 1.5-7.3 P = 0.001), lower lymph node ratio (HR 1.2, 95% CI:1.0-1.3 P = 0.007), lower number of positive nodes (HR 1.1, 95% CI:1.0-1.2 P = 0.004) and the use of radiation therapy (HR 0.5, 95% CI:0.3-0.9 P = 0.012).

CONCLUSION

Metastasis to the axilla and groin with cSCC has poor outcomes with standard treatment. The addition of immunotherapy warrants investigation.