Cutaneous Squamous Cell Carcinoma in Immunocompromised Patients—A Comparison between Different Immunomodulating Conditions
Background: Immunosuppression is strongly associated with an increased risk of developing cutaneous squamous cell carcinoma (cSCC). Studies on solid organ transplant recipients (SOTR) and chronic lymphocytic leukemia (CLL) patients have already demonstrated higher rates of aggressive cSCC tumors in...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-03-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/6/1764 |
| _version_ | 1797613015145644032 |
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| author | Ofir Zavdy Tara Coreanu Dvir Yohai Bar-On Amit Ritter Gideon Bachar Thomas Shpitzer Noga Kurman Muhammad Mansour Dean Ad-El Uri Rozovski Gilad Itchaki Shany Sherman Limor Azulay-Gitter Aviram Mizrachi |
| author_facet | Ofir Zavdy Tara Coreanu Dvir Yohai Bar-On Amit Ritter Gideon Bachar Thomas Shpitzer Noga Kurman Muhammad Mansour Dean Ad-El Uri Rozovski Gilad Itchaki Shany Sherman Limor Azulay-Gitter Aviram Mizrachi |
| author_sort | Ofir Zavdy |
| collection | DOAJ |
| description | Background: Immunosuppression is strongly associated with an increased risk of developing cutaneous squamous cell carcinoma (cSCC). Studies on solid organ transplant recipients (SOTR) and chronic lymphocytic leukemia (CLL) patients have already demonstrated higher rates of aggressive cSCC tumors in these populations compared to immunocompetent controls. Studies on other immunosuppressed patient groups are scarce. This study was aimed at assessing the effects of different immunomodulating conditions on patients diagnosed with cSCC. We sought to compare the clinical features, treatments, and survival rates among the different study groups, as well as outcomes to those of immunocompetent controls with cSCC. Methods: A retrospective analysis of 465 cSCC patients, both immunosuppressed (IS) and immunocompetent controls. Etiologies for immunosuppression included SOTR, CLL, chronic kidney disease (CKD), psoriasis, rheumatoid arthritis (RA) and systemic lupus erythematous (SLE). Results: Compared to the control group, IS patients demonstrated several significant differences. These include higher rates of positive resection margins, higher recurrence rates, and multiple SCC tumors. Patients in the IS group, who were also given immunomodulating agents, demonstrated even lower survival rates. Cox regression analysis demonstrated statistically significant decreased overall survival (OS) rates for IS patients compared to the controls (OR = 1.9, <i>p</i> = 0.031). SOTR patients tend to have multiple cSCC tumors (35%), with the highest number of primary tumors compared to controls (2.54 tumors per patient on average, <i>p</i> < 0.001), but also compared to all other IS groups. The average SCC lesion size in the SOTR group was the smallest, measuring at 13.5 mm, compared to the control group and all other IS groups. Decreased survival rates were seen on Cox regression analysis compared to controls (HR = 2.4, <i>p</i> = 0.001), but also to all other IS groups. CLL patients also had the highest rates of positive margins compared to controls (36% vs. 9%, <i>p</i> < 0.01) and to all other IS groups. They were also most likely to get adjuvant or definitive oncological treatments, either radiotherapy or chemotherapy, compared to controls (36% vs. 15%, <i>p</i> = 0.02) and to other IS groups. Patients in the CKD group demonstrated the highest rates for multiple cSCC (OR = 4.7, <i>p</i> = 0.001) and the worst rates of survival on Cox regression analysis (HR = 3.2, <i>p</i> = 0.001). Both rheumatoid arthritis and psoriasis patients demonstrated the shortest disease-free survival rates (2.9y ± 1.1, 2.3y ± 0.7, respectively), compared to controls (4.1y ± 2.8) and to all other IS groups. Conclusions: Among cSCC patients, immunosuppression due to SOTR, CLL, CKD, RA, and psoriasis is associated with worse outcomes compared to controls and other IS groups. These patients should be regarded as high-risk for developing aggressive cSCC tumors. This study is the first to assess and compare cSCC outcomes among multiple IS patient groups. |
| first_indexed | 2024-03-11T06:48:59Z |
| format | Article |
| id | doaj.art-c50c489e88ec4abda9923f0285845db8 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T06:48:59Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-c50c489e88ec4abda9923f0285845db82023-11-17T10:06:53ZengMDPI AGCancers2072-66942023-03-01156176410.3390/cancers15061764Cutaneous Squamous Cell Carcinoma in Immunocompromised Patients—A Comparison between Different Immunomodulating ConditionsOfir Zavdy0Tara Coreanu1Dvir Yohai Bar-On2Amit Ritter3Gideon Bachar4Thomas Shpitzer5Noga Kurman6Muhammad Mansour7Dean Ad-El8Uri Rozovski9Gilad Itchaki10Shany Sherman11Limor Azulay-Gitter12Aviram Mizrachi13Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva 4941492, IsraelDepartment of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva 4941492, IsraelDepartment of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva 4941492, IsraelDepartment of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva 4941492, IsraelDepartment of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva 4941492, IsraelDepartment of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva 4941492, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, IsraelDepartment of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva 4941492, IsraelBackground: Immunosuppression is strongly associated with an increased risk of developing cutaneous squamous cell carcinoma (cSCC). Studies on solid organ transplant recipients (SOTR) and chronic lymphocytic leukemia (CLL) patients have already demonstrated higher rates of aggressive cSCC tumors in these populations compared to immunocompetent controls. Studies on other immunosuppressed patient groups are scarce. This study was aimed at assessing the effects of different immunomodulating conditions on patients diagnosed with cSCC. We sought to compare the clinical features, treatments, and survival rates among the different study groups, as well as outcomes to those of immunocompetent controls with cSCC. Methods: A retrospective analysis of 465 cSCC patients, both immunosuppressed (IS) and immunocompetent controls. Etiologies for immunosuppression included SOTR, CLL, chronic kidney disease (CKD), psoriasis, rheumatoid arthritis (RA) and systemic lupus erythematous (SLE). Results: Compared to the control group, IS patients demonstrated several significant differences. These include higher rates of positive resection margins, higher recurrence rates, and multiple SCC tumors. Patients in the IS group, who were also given immunomodulating agents, demonstrated even lower survival rates. Cox regression analysis demonstrated statistically significant decreased overall survival (OS) rates for IS patients compared to the controls (OR = 1.9, <i>p</i> = 0.031). SOTR patients tend to have multiple cSCC tumors (35%), with the highest number of primary tumors compared to controls (2.54 tumors per patient on average, <i>p</i> < 0.001), but also compared to all other IS groups. The average SCC lesion size in the SOTR group was the smallest, measuring at 13.5 mm, compared to the control group and all other IS groups. Decreased survival rates were seen on Cox regression analysis compared to controls (HR = 2.4, <i>p</i> = 0.001), but also to all other IS groups. CLL patients also had the highest rates of positive margins compared to controls (36% vs. 9%, <i>p</i> < 0.01) and to all other IS groups. They were also most likely to get adjuvant or definitive oncological treatments, either radiotherapy or chemotherapy, compared to controls (36% vs. 15%, <i>p</i> = 0.02) and to other IS groups. Patients in the CKD group demonstrated the highest rates for multiple cSCC (OR = 4.7, <i>p</i> = 0.001) and the worst rates of survival on Cox regression analysis (HR = 3.2, <i>p</i> = 0.001). Both rheumatoid arthritis and psoriasis patients demonstrated the shortest disease-free survival rates (2.9y ± 1.1, 2.3y ± 0.7, respectively), compared to controls (4.1y ± 2.8) and to all other IS groups. Conclusions: Among cSCC patients, immunosuppression due to SOTR, CLL, CKD, RA, and psoriasis is associated with worse outcomes compared to controls and other IS groups. These patients should be regarded as high-risk for developing aggressive cSCC tumors. This study is the first to assess and compare cSCC outcomes among multiple IS patient groups.https://www.mdpi.com/2072-6694/15/6/1764cutaneous SCCimmunosuppressionnon-melanoma skin cancertransplantsCLLchronic kidney disease |
| spellingShingle | Ofir Zavdy Tara Coreanu Dvir Yohai Bar-On Amit Ritter Gideon Bachar Thomas Shpitzer Noga Kurman Muhammad Mansour Dean Ad-El Uri Rozovski Gilad Itchaki Shany Sherman Limor Azulay-Gitter Aviram Mizrachi Cutaneous Squamous Cell Carcinoma in Immunocompromised Patients—A Comparison between Different Immunomodulating Conditions Cancers cutaneous SCC immunosuppression non-melanoma skin cancer transplants CLL chronic kidney disease |
| title | Cutaneous Squamous Cell Carcinoma in Immunocompromised Patients—A Comparison between Different Immunomodulating Conditions |
| title_full | Cutaneous Squamous Cell Carcinoma in Immunocompromised Patients—A Comparison between Different Immunomodulating Conditions |
| title_fullStr | Cutaneous Squamous Cell Carcinoma in Immunocompromised Patients—A Comparison between Different Immunomodulating Conditions |
| title_full_unstemmed | Cutaneous Squamous Cell Carcinoma in Immunocompromised Patients—A Comparison between Different Immunomodulating Conditions |
| title_short | Cutaneous Squamous Cell Carcinoma in Immunocompromised Patients—A Comparison between Different Immunomodulating Conditions |
| title_sort | cutaneous squamous cell carcinoma in immunocompromised patients a comparison between different immunomodulating conditions |
| topic | cutaneous SCC immunosuppression non-melanoma skin cancer transplants CLL chronic kidney disease |
| url | https://www.mdpi.com/2072-6694/15/6/1764 |
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