Immunosuppression is a risk factor for worse survival and disease‐specific death in cutaneous squamous cell carcinoma

• Published in: JEADV clinical practice Vol. 3; no. 1; pp. 182 - 190
• Main Authors: Greene, Adina, Hwang, Angelina S., Kechter, Jacob A., Boudreaux, Blake W., Bhullar, Puneet, Severson, Kevin J., Butterfield, Richard J., Zhang, Nan, Tolaymat, Leila M., Degesys, Catherine A., Ochoa, Shari A., Arpey, Christopher J., Baum, Christian L., Mangold, Aaron R.
• Format: Journal Article
• Language: English
• Published: Madrid John Wiley & Sons, Inc 01-03-2024; Wiley
• Subjects: Age; cutaneous squamous cell carcinoma; Demographics; Immunocompetence; immunosuppression; Metastasis; Patients; Population; Risk factors; Skin cancer; solid organ transplant recipients; Squamous cell carcinoma; Stem cell transplantation; Tumors
• ISSN: 2768-6566; 2768-6566
• DOI: 10.1002/jvc2.265

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.
Extensive comparison of cutaneous squamous cell carcinoma (cSCC) tumour characteristics and outcomes were performed through a retrospective review of 935 cSCC cases from the Mayo Clinic.
Immunosuppression was associated with younger age, male gender, and higher grade tumour characterized by moderate or poor differentiation.
Immunosuppressed patients had an increased risk of disease‐specific death (HR [95% 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). Notably, solid organ transplant recipients had the lowest overall survival when stratified by immunosuppression type (HR [95% CI] 1.62 [1.17–2.24], p < 0.0001).