Personalised decision making to predict absolute metastatic risk in cutaneous squamous cell carcinoma: development and validation of a clinico-pathological modelResearch in context
Summary: Background: Cutaneous squamous cell carcinoma (cSCC) is a common skin cancer, affecting more than 2 million people worldwide yearly and metastasising in 2–5% of patients. However, current clinical staging systems do not provide estimates of absolute metastatic risk, hence missing the oppor...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537023003279 |
| _version_ | 1797740787654459392 |
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| author | Barbara Rentroia-Pacheco Selin Tokez Edo M. Bramer Zoe C. Venables Harmen J.G. van de Werken Domenico Bellomo David van Klaveren Antien L. Mooyaart Loes M. Hollestein Marlies Wakkee |
| author_facet | Barbara Rentroia-Pacheco Selin Tokez Edo M. Bramer Zoe C. Venables Harmen J.G. van de Werken Domenico Bellomo David van Klaveren Antien L. Mooyaart Loes M. Hollestein Marlies Wakkee |
| author_sort | Barbara Rentroia-Pacheco |
| collection | DOAJ |
| description | Summary: Background: Cutaneous squamous cell carcinoma (cSCC) is a common skin cancer, affecting more than 2 million people worldwide yearly and metastasising in 2–5% of patients. However, current clinical staging systems do not provide estimates of absolute metastatic risk, hence missing the opportunity for more personalised treatment advice. We aimed to develop a clinico-pathological model that predicts the probability of metastasis in patients with cSCC. Methods: Nationwide cohorts from (1) all patients with a first primary cSCC in The Netherlands in 2007–2008 and (2) all patients with a cSCC in 2013–2015 in England were used to derive nested case–control cohorts. Pathology records of primary cSCCs that originated a loco-regional or distant metastasis were identified, and these cSCCs were matched to primary cSCCs of controls without metastasis (1:1 ratio). The model was developed on the Dutch cohort (n = 390) using a weighted Cox regression model with backward selection and validated on the English cohort (n = 696). Model performance was assessed using weighted versions of the C-index, calibration metrics, and decision curve analysis; and compared to the Brigham and Women's Hospital (BWH) and the American Joint Committee on Cancer (AJCC) staging systems. Members of the multidisciplinary Skin Cancer Outcomes (SCOUT) consortium were surveyed to interpret metastatic risk cutoffs in a clinical context. Findings: Eight out of eleven clinico-pathological variables were selected. The model showed good discriminative ability, with an optimism-corrected C-index of 0.80 (95% Confidence interval (CI) 0.75–0.85) in the development cohort and a C-index of 0.84 (95% CI 0.81–0.87) in the validation cohort. Model predictions were well-calibrated: the calibration slope was 0.96 (95% CI 0.76–1.16) in the validation cohort. Decision curve analysis showed improved net benefit compared to current staging systems, particularly for thresholds relevant for decisions on follow-up and adjuvant treatment. The model is available as an online web-based calculator (https://emc-dermatology.shinyapps.io/cscc-abs-met-risk/). Interpretation: This validated model assigns personalised metastatic risk predictions to patients with cSCC, using routinely reported histological and patient-specific risk factors. The model can empower clinicians and healthcare systems in identifying patients with high-risk cSCC and offering personalised care/treatment and follow-up. Use of the model for clinical decision-making in different patient populations must be further investigated. Funding: PPP Allowance made available by Health-Holland, Top Sector Life Sciences & Health, to stimulate public-private partnerships. |
| first_indexed | 2024-03-12T14:17:26Z |
| format | Article |
| id | doaj.art-5c3c9ba20bcf412bb28d2d5305289726 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-03-12T14:17:26Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-5c3c9ba20bcf412bb28d2d53052897262023-08-20T04:38:29ZengElsevierEClinicalMedicine2589-53702023-09-0163102150Personalised decision making to predict absolute metastatic risk in cutaneous squamous cell carcinoma: development and validation of a clinico-pathological modelResearch in contextBarbara Rentroia-Pacheco0Selin Tokez1Edo M. Bramer2Zoe C. Venables3Harmen J.G. van de Werken4Domenico Bellomo5David van Klaveren6Antien L. Mooyaart7Loes M. Hollestein8Marlies Wakkee9Department of Dermatology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the NetherlandsDepartment of Dermatology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the NetherlandsDepartment of Dermatology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the NetherlandsDepartment of Dermatology, Norfolk and Norwich University Hospital, Norwich, United Kingdom; National Disease Registration Service, NHS England, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United KingdomDepartment of Immunology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the NetherlandsSkylineDx B.V., Rotterdam, the NetherlandsDepartment of Public Health, Center for Medical Decision Making, Erasmus University Medical Center, Rotterdam, the NetherlandsDepartment of Pathology, Erasmus University Medical Center, Rotterdam, the NetherlandsDepartment of Dermatology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the NetherlandsDepartment of Dermatology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands; Corresponding author. Department of Dermatology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam 3015 GD, the Netherlands.Summary: Background: Cutaneous squamous cell carcinoma (cSCC) is a common skin cancer, affecting more than 2 million people worldwide yearly and metastasising in 2–5% of patients. However, current clinical staging systems do not provide estimates of absolute metastatic risk, hence missing the opportunity for more personalised treatment advice. We aimed to develop a clinico-pathological model that predicts the probability of metastasis in patients with cSCC. Methods: Nationwide cohorts from (1) all patients with a first primary cSCC in The Netherlands in 2007–2008 and (2) all patients with a cSCC in 2013–2015 in England were used to derive nested case–control cohorts. Pathology records of primary cSCCs that originated a loco-regional or distant metastasis were identified, and these cSCCs were matched to primary cSCCs of controls without metastasis (1:1 ratio). The model was developed on the Dutch cohort (n = 390) using a weighted Cox regression model with backward selection and validated on the English cohort (n = 696). Model performance was assessed using weighted versions of the C-index, calibration metrics, and decision curve analysis; and compared to the Brigham and Women's Hospital (BWH) and the American Joint Committee on Cancer (AJCC) staging systems. Members of the multidisciplinary Skin Cancer Outcomes (SCOUT) consortium were surveyed to interpret metastatic risk cutoffs in a clinical context. Findings: Eight out of eleven clinico-pathological variables were selected. The model showed good discriminative ability, with an optimism-corrected C-index of 0.80 (95% Confidence interval (CI) 0.75–0.85) in the development cohort and a C-index of 0.84 (95% CI 0.81–0.87) in the validation cohort. Model predictions were well-calibrated: the calibration slope was 0.96 (95% CI 0.76–1.16) in the validation cohort. Decision curve analysis showed improved net benefit compared to current staging systems, particularly for thresholds relevant for decisions on follow-up and adjuvant treatment. The model is available as an online web-based calculator (https://emc-dermatology.shinyapps.io/cscc-abs-met-risk/). Interpretation: This validated model assigns personalised metastatic risk predictions to patients with cSCC, using routinely reported histological and patient-specific risk factors. The model can empower clinicians and healthcare systems in identifying patients with high-risk cSCC and offering personalised care/treatment and follow-up. Use of the model for clinical decision-making in different patient populations must be further investigated. Funding: PPP Allowance made available by Health-Holland, Top Sector Life Sciences & Health, to stimulate public-private partnerships.http://www.sciencedirect.com/science/article/pii/S2589537023003279Cutaneous squamous cell carcinomaMetastasisPrognostic modelAbsolute riskPersonalised medicineClinical decision support |
| spellingShingle | Barbara Rentroia-Pacheco Selin Tokez Edo M. Bramer Zoe C. Venables Harmen J.G. van de Werken Domenico Bellomo David van Klaveren Antien L. Mooyaart Loes M. Hollestein Marlies Wakkee Personalised decision making to predict absolute metastatic risk in cutaneous squamous cell carcinoma: development and validation of a clinico-pathological modelResearch in context EClinicalMedicine Cutaneous squamous cell carcinoma Metastasis Prognostic model Absolute risk Personalised medicine Clinical decision support |
| title | Personalised decision making to predict absolute metastatic risk in cutaneous squamous cell carcinoma: development and validation of a clinico-pathological modelResearch in context |
| title_full | Personalised decision making to predict absolute metastatic risk in cutaneous squamous cell carcinoma: development and validation of a clinico-pathological modelResearch in context |
| title_fullStr | Personalised decision making to predict absolute metastatic risk in cutaneous squamous cell carcinoma: development and validation of a clinico-pathological modelResearch in context |
| title_full_unstemmed | Personalised decision making to predict absolute metastatic risk in cutaneous squamous cell carcinoma: development and validation of a clinico-pathological modelResearch in context |
| title_short | Personalised decision making to predict absolute metastatic risk in cutaneous squamous cell carcinoma: development and validation of a clinico-pathological modelResearch in context |
| title_sort | personalised decision making to predict absolute metastatic risk in cutaneous squamous cell carcinoma development and validation of a clinico pathological modelresearch in context |
| topic | Cutaneous squamous cell carcinoma Metastasis Prognostic model Absolute risk Personalised medicine Clinical decision support |
| url | http://www.sciencedirect.com/science/article/pii/S2589537023003279 |
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