Immunosuppression as an Independent Risk Factor for Poor Outcomes in Cutaneous Squamous Cell Carcinoma: A Prospective
Amanda Rosenthal1,2, Geena Conde3, Joseph Dodson2
1Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, California.
Summary
Immunosuppression significantly increases the risk of poor outcomes in cutaneous squamous cell carcinoma (cSCC). This factor is a stronger predictor of adverse events than traditional high-risk features in cSCC patients.
Area of Science:
- Dermatology
- Oncology
- Immunology
Background:
- The prognostic implications of immunosuppression in cutaneous squamous cell carcinoma (cSCC) are not well-defined.
- Understanding risk factors is crucial for managing cSCC, a common skin cancer.
Purpose of the Study:
- To quantify the impact of immunosuppression on poor outcomes in cSCC.
- To compare the predictive value of immunosuppression against established high-risk features.
Main Methods:
- A single-center prospective study analyzed 1,400 cSCC cases from 929 patients (2014-2021).
- Outcomes included recurrence, nodal involvement, metastasis, and cSCC-specific mortality.
- Multivariate logistic regression identified independent predictors of poor outcomes.
Main Results:
- 16.8% of patients were immunosuppressed and showed higher rates of advanced tumors and poor outcomes.
- Immunosuppression was an independent predictor of poor outcomes (AOR: 3.44; p = .011).
- Immunosuppression outperformed tumor size, perineural invasion, and deep invasion in predicting poor outcomes.
Conclusions:
- Immunosuppression is a significant independent predictor of poor outcomes in cSCC.
- It surpasses traditional high-risk features in prognostic value.
- cSCC in immunosuppressed individuals may exhibit distinct, aggressive biology beyond current staging.
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