Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
JAMA Dermatol. 2013 May;149(5):541-7. doi: 10.1001/jamadermatol.2013.2139.
Although most cases of cutaneous squamous cell carcinoma (CSCC) are easily cured with surgery or ablation, a subset of these tumors recur, metastasize, and cause death. We conducted the largest study of CSCC outcomes since 1968.
To identify risk factors independently associated with poor outcomes in primary CSCC.
A 10-year retrospective cohort study.
An academic hospital in Boston.
Nine hundred eighty-five patients with 1832 tumors.
Subhazard ratios for local recurrence, nodal metastasis, disease-specific death, and all-cause death adjusted for presence of known prognostic risk factors.
The median follow-up was 50 (range, 2-142) months. Local recurrence occurred in 45 patients (4.6%) during the study period; 36 (3.7%) developed nodal metastases; and 21 (2.1%) died of CSCC. In multivariate competing risk analyses, independent predictors for nodal metastasis and disease-specific death were a tumor diameter of at least 2 cm (subhazard ratios, 7.0 [95% CI, 2.2-21.6] and 15.9 [4.8-52.3], respectively), poor differentiation (6.1 [2.5-14.9] and 6.7 [2.7-16.5], respectively), invasion beyond fat (9.3 [2.8-31.1] and 13.0 [4.3-40.0], respectively), and ear or temple location (3.8 [1.1-13.4] and 5.9 [1.3-26.7], respectively). Perineural invasion was also associated with disease-specific death (subhazard ratio, 3.6 [95% CI, 1.1-12.0]), as was anogenital location, but few cases were anogenital. Overall death was associated with poor differentiation (subhazard ratio, 1.3 [95% CI, 1.1-1.6]) and invasion beyond fat (1.7 [1.1-2.8]).
Cutaneous squamous cell carcinoma carries a low but significant risk of metastasis and death. In this study, patients with CSCC had a 3.7% risk of metastasis and 2.1% risk of disease-specific death. Tumor diameter of at least 2 cm, invasion beyond fat, poor differentiation, perineural invasion, and ear, temple, or anogenital location were risk factors associated with poor outcomes. Accurate risk estimation of outcomes from population-based data and clinical trials proving the utility of disease-staging modalities and adjuvant therapy is needed.
尽管大多数皮肤鳞状细胞癌 (CSCC) 病例很容易通过手术或消融治愈，但其中一部分肿瘤会复发、转移并导致死亡。我们进行了自 1968 年以来 CSCC 结果的最大规模研究。
确定与原发性 CSCC 不良结局相关的独立风险因素。
一项为期 10 年的回顾性队列研究。
波士顿的一家学术医院。
985 名患有 1832 个肿瘤的患者。
局部复发、淋巴结转移、疾病特异性死亡和全因死亡的亚危险比，调整了已知预后风险因素的存在。
中位随访时间为 50 个月（范围，2-142）。研究期间有 45 名患者（4.6%）出现局部复发；36 名（3.7%）发生淋巴结转移；21 名（2.1%）死于 CSCC。在多变量竞争风险分析中，淋巴结转移和疾病特异性死亡的独立预测因素是肿瘤直径至少为 2 cm（亚危险比，7.0[95%CI，2.2-21.6]和 15.9[4.8-52.3]）、分化差（6.1[2.5-14.9]和 6.7[2.7-16.5]）、侵犯脂肪以外的组织（9.3[2.8-31.1]和 13.0[4.3-40.0]）以及耳部或太阳穴位置（3.8[1.1-13.4]和 5.9[1.3-26.7]）。神经周围侵犯也与疾病特异性死亡相关（亚危险比，3.6[95%CI，1.1-12.0]），肛生殖器部位也与疾病特异性死亡相关，但肛生殖器部位的病例很少。总死亡率与分化差（亚危险比，1.3[95%CI，1.1-1.6]）和侵犯脂肪以外的组织（1.7[1.1-2.8]）相关。
皮肤鳞状细胞癌有转移和死亡的低但显著风险。在这项研究中，CSCC 患者的转移风险为 3.7%，疾病特异性死亡风险为 2.1%。肿瘤直径至少 2 cm、侵犯脂肪以外的组织、分化差、神经周围侵犯以及耳部、太阳穴或肛生殖器部位是与不良结局相关的风险因素。需要基于人群数据进行准确的风险评估，临床试验证明疾病分期方式和辅助治疗的有效性。
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