Predictors of Recurrence and Progression in Poorly Differentiated Cutaneous Squamous Cell Carcinomas: Insights from a Real-Life Experience.

IF 3 3区 医学 Q2 DERMATOLOGY Dermatology Pub Date : 2024-01-01 Epub Date: 2023-11-26 DOI:10.1159/000535040
Gabriele Roccuzzo, Giulia Orlando, Maria Rebecca Rumore, Antonio Morrone, Enrico Fruttero, Virginia Caliendo, Franco Picciotto, Alberto Sciarrillo, Pietro Quaglino, Paola Cassoni, Simone Ribero, Rebecca Senetta
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引用次数: 0

Abstract

Introduction: Surgery represents the primary treatment option for cutaneous squamous cell carcinoma (cSCC) aiming for complete tumor resection (R0). Recurrence and metastasis significantly affect survival and outcomes, and poorly differentiated (G3) cSCC is associated with a higher risk of recurrence. However, the specific clinical and histopathological features that predict recurrence and progression in G3-cSCC remain unclear.

Methods: A retrospective analysis was conducted on a series of patients with primary G3-cSCC diagnosed at the Turin University Hospital between January 2016 and January 2021. After independent histological revision, logistic regression models were used to identify clinico-pathological predictors of cutaneous recurrence, lymphnode/metastatic progression, and both types of progression.

Results: Among the 161 G3-cSCC patients, 80.1% (129/161) showed no signs of local recurrence or metastatic progression, while 19.9% (32 patients) had progressed. In the univariate logistic regression, tumor clinical diameter, depth of infiltration (DOI), and lymphovascular invasion (LVI) were identified as significant predictors across the various types of progression (p < 0.05). In the context of multivariate logistic regression, distinct models proved to be significant. For skin recurrence, a 3-variable model incorporating DOI (OR 1.16, 95% CI, 1.01-1.35, p = 0.050), LVI (OR 3.61, 95% CI, 1.11-11.8, p = 0.034), and desmoplasia (OR 3.45, 95% CI, 1.25-9.5, p = 0.017) was selected. Regarding lymphnode/metastatic progression, a 3-variable model combining pT2 (OR 6.10, 95% CI, 1.15-32.35, p = 0.034), pT3 (OR 14.33, 95% CI, 2.79-73.63, p = 0.001), and LVI (OR 3.86, 95% CI, 1.10-13.62, p = 0.036) was identified. Lastly, a 2-variable model for both types of progression consisted of vertical tumor thickness (OR 5.45, 95% CI, 1.11-27.32, p = 0.039) and LVI (OR 1.15, 95% CI, 1.04-1.26, p = 0.006).

Conclusion: Tumor size, DOI, and LVI were significant predictors of recurrence and metastatic progression. Notably, the size of histologically defined tumor-free margins did not affect the risk of recurrence, whilst LVI emerged as a key predictor of all forms of progression. These findings provide insights into risk stratification and suggest that close monitoring and potential adjuvant therapies, such as radiation therapy, may be necessary especially for patients with lymphovascular involvement.

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低分化皮肤鳞状细胞癌复发和进展的预测因素:来自现实生活经验的见解。
手术是皮肤鳞状细胞癌(cSCC)的主要治疗选择,旨在完全切除肿瘤(R0)。复发和转移显著影响生存和预后,低分化(G3) cSCC与较高的复发风险相关。然而,预测G3-cSCC复发和进展的具体临床和组织病理学特征仍不清楚。方法回顾性分析2016年1月至2021年1月在都灵大学医院诊断的一系列原发性G3-cSCC患者。在独立的组织学修订后,使用逻辑回归模型来确定皮肤复发,淋巴结/转移进展以及两种类型进展的临床病理预测因子。结果161例G3-cSCC患者中,80.1%(129/161)未出现局部复发或转移进展迹象,19.9%(32例)出现进展。在单变量logistic回归中,肿瘤临床直径、浸润深度(DOI)和淋巴血管侵袭(LVI)被确定为各种类型进展的重要预测因素(p . 422)
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来源期刊
Dermatology
Dermatology 医学-皮肤病学
CiteScore
6.40
自引率
2.90%
发文量
71
审稿时长
1 months
期刊介绍: Published since 1893, ''Dermatology'' provides a worldwide survey of clinical and investigative dermatology. Original papers report clinical and laboratory findings. In order to inform readers of the implications of recent research, editorials and reviews prepared by invited, internationally recognized scientists are regularly featured. In addition to original papers, the journal publishes rapid communications, short communications, and letters to ''Dermatology''. ''Dermatology'' answers the complete information needs of practitioners concerned with progress in research related to skin, clinical dermatology and therapy. The journal enjoys a high scientific reputation with a continually increasing impact factor and an equally high circulation.
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