Immunosuppression is a risk factor for worse survival and disease‐specific death in cutaneous squamous cell carcinoma
Abstract 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...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-03-01
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| Series: | JEADV Clinical Practice |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jvc2.265 |
| _version_ | 1797289336709840896 |
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| author | Adina Greene Angelina S. Hwang Jacob A. Kechter Blake W. Boudreaux Puneet Bhullar Kevin J. Severson Richard J. Butterfield Nan Zhang Leila M. Tolaymat Catherine A. Degesys Shari A. Ochoa Christopher J. Arpey Christian L. Baum Aaron R. Mangold |
| author_facet | Adina Greene Angelina S. Hwang Jacob A. Kechter Blake W. Boudreaux Puneet Bhullar Kevin J. Severson Richard J. Butterfield Nan Zhang Leila M. Tolaymat Catherine A. Degesys Shari A. Ochoa Christopher J. Arpey Christian L. Baum Aaron R. Mangold |
| author_sort | Adina Greene |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-03-07T19:02:31Z |
| format | Article |
| id | doaj.art-893e4079dbc64693a3b8a644717f9d36 |
| institution | Directory Open Access Journal |
| issn | 2768-6566 |
| language | English |
| last_indexed | 2024-03-07T19:02:31Z |
| publishDate | 2024-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | JEADV Clinical Practice |
| spelling | doaj.art-893e4079dbc64693a3b8a644717f9d362024-03-01T11:39:22ZengWileyJEADV Clinical Practice2768-65662024-03-013118219010.1002/jvc2.265Immunosuppression is a risk factor for worse survival and disease‐specific death in cutaneous squamous cell carcinomaAdina Greene0Angelina S. Hwang1Jacob A. Kechter2Blake W. Boudreaux3Puneet Bhullar4Kevin J. Severson5Richard J. Butterfield6Nan Zhang7Leila M. Tolaymat8Catherine A. Degesys9Shari A. Ochoa10Christopher J. Arpey11Christian L. Baum12Aaron R. Mangold13College of Medicine‐Phoenix University of Arizona Phoenix Arizona USADepartment of Dermatology Mayo Clinic Scottsdale Arizona USADepartment of Dermatology Mayo Clinic Scottsdale Arizona USADepartment of Dermatology Mayo Clinic Scottsdale Arizona USADepartment of Dermatology Mayo Clinic Scottsdale Arizona USADepartment of Dermatology Mayo Clinic Scottsdale Arizona USADepartment of Quantitative Health Sciences Mayo Clinic Scottsdale Arizona USADepartment of Quantitative Health Sciences Mayo Clinic Scottsdale Arizona USADepartment of Dermatology Mayo Clinic Jacksonville Florida USADepartment of Dermatology Mayo Clinic Jacksonville Florida USADepartment of Dermatology Mayo Clinic Scottsdale Arizona USADepartment of Dermatology Mayo Clinic Scottsdale Arizona USADepartment of Dermatology Mayo Clinic Rochester Minnesota USADepartment of Dermatology Mayo Clinic Scottsdale Arizona USAAbstract 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.https://doi.org/10.1002/jvc2.265cutaneous squamous cell carcinomaimmunosuppressionsolid organ transplant recipients |
| spellingShingle | Adina Greene Angelina S. Hwang Jacob A. Kechter Blake W. Boudreaux Puneet Bhullar Kevin J. Severson Richard J. Butterfield Nan Zhang Leila M. Tolaymat Catherine A. Degesys Shari A. Ochoa Christopher J. Arpey Christian L. Baum Aaron R. Mangold Immunosuppression is a risk factor for worse survival and disease‐specific death in cutaneous squamous cell carcinoma JEADV Clinical Practice cutaneous squamous cell carcinoma immunosuppression solid organ transplant recipients |
| title | Immunosuppression is a risk factor for worse survival and disease‐specific death in cutaneous squamous cell carcinoma |
| title_full | Immunosuppression is a risk factor for worse survival and disease‐specific death in cutaneous squamous cell carcinoma |
| title_fullStr | Immunosuppression is a risk factor for worse survival and disease‐specific death in cutaneous squamous cell carcinoma |
| title_full_unstemmed | Immunosuppression is a risk factor for worse survival and disease‐specific death in cutaneous squamous cell carcinoma |
| title_short | Immunosuppression is a risk factor for worse survival and disease‐specific death in cutaneous squamous cell carcinoma |
| title_sort | immunosuppression is a risk factor for worse survival and disease specific death in cutaneous squamous cell carcinoma |
| topic | cutaneous squamous cell carcinoma immunosuppression solid organ transplant recipients |
| url | https://doi.org/10.1002/jvc2.265 |
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