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Enhanced metastatic risk stratification for cutaneous squamous cell carcinoma by combining clinical guidelines with
O F M Steijlen1, L Pozza2, J J H Traets2
1Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Background:
Reliably assessing metastatic risk in cutaneous squamous cell carcinoma remains clinically challenging despite established guidelines.
Objective:
To assess whether a clinicopathologic risk prediction model (Erasmus MC model) can enhance the identification of high-risk metastatic patients within the current European and National Comprehensive Cancer Network guidelines for cutaneous squamous cell carcinoma.
Methods:
A Dutch nested case-control cohort (n = 390 derived from N = 12,325), was first stratified by guideline-defined risk groups. Each high-risk group was further stratified using thresholds for the risk estimated by the Erasmus MC model. The performance was assessed in an independent English nested case-control cohort (n = 696, derived from N = 31,981).
Results:
The European guideline-defined high-risk group had a 3-year metastatic risk of 3.8% (95% CI 2.4% to 5.2%). Within this group, 18.2% of the patients were identified with a higher 3-year risk of 10.1% (95% CI 6.7% to 13.5%). For the National Comprehensive Cancer Network-defined very high-risk group, the overall 3-year risk was 7.4% (95% CI 2.0% to 9.2%). Of these, 34.5% of the patients had an even greater risk of 14.0% (95% CI 8.3% to 19.6%).
Limitations:
Routinely collected health care data often lacks detailed clinical information.
Conclusion:
The Erasmus MC model improves metastatic risk stratification by identifying higher risk groups within the frameworks of current European and National Comprehensive Cancer Network cutaneous squamous cell carcinoma guidelines.
