Impact of immunosuppression on cutaneous squamous cell carcinoma outcomes

Immunosuppression is associated with a higher risk of developing cutaneous squamous cell carcinoma (CSCC) and more aggressive tumors, but its role as an independent predictor of poor outcomes remains unclear.

To determine whether immunosuppression independently predicts poor outcomes in CSCC.

This was a retrospective cohort study with pooled data from 12 international centers. Demographics, immunosuppression status, tumor characteristics, treatment, and outcomes were collected. Univariable and multivariable marginal Fine and Gray competing risk analyses were performed. Subgroup multivariable analyses were performed on the organ transplant and chronic lymphocytic leukemia cohorts.

A total of 11,930 patients with 18,760 tumors (14,766 in immunocompetent and 3994 in immunosuppressed) were included. Immunosuppressed patients had a higher prevalence of high-risk tumor features and poor disease outcomes. On multivariable analysis, immunosuppression was independently associated with local recurrence (LR), distant metastasis, disease-specific death (DSD), and major poor outcomes. Organ transplantation was predictive of LR, distant metastasis, and DSD, whereas chronic lymphocytic leukemia independently predicted LR, DSD, and major poor outcomes.

A retrospective design, potential for data heterogeneity.

Immunosuppression is an independent risk factor for major poor outcomes in CSCC and should be included in risk nomograms.