Agar Nicholas J M, Kirton Christopher, Patel Rajan S, Martin Richard C W, Angelo Neville, Emanuel Patrick O
Department of Pathology and Molecular Medicine, Auckland City Hospital (Grafton Campus), Auckland, New Zealand.
N Z Med J. 2015 Mar 27;128(1411):59-67.
Predicting which patients will develop nodal metastasis from cutaneous squamous cell carcinoma (cSCC) remains difficult. This study evaluates a recently described histological risk model validated for mucosal head and neck SCC (HNSCC) when applied to cutaneous tumours. In this model, morphologic variables including worst pattern of invasion, lymphocytic host response and perineural invasion were shown to predict disease recurrence, loco regional recurrence and overall survival in mucosal HNSCC.
Patients with cSCC and known metastatic spread were identified from the author's database over a 5-year period between July 2007 and July 2012. Histology specimens from the original primary tumour were separately analysed by 2 histopathologists. Scores were compared against T-Stage matched control specimens without metastatic spread.
27 patients with metastatic cSCC were identified. Scores for worst pattern of invasion (WPOI) were significantly higher in individuals with lymph node metastases (p=0.02).
Adverse pattern of invasion, defined as presence of small tumour islands or tumour satellites may be an independent risk factor for developing nodal metastases in cSCC. These tumours are difficult to investigate histopathologically as it is difficult to be confident the correct primary is chosen for study.
预测哪些皮肤鳞状细胞癌（cSCC）患者会发生淋巴结转移仍然很困难。本研究评估了一种最近描述的组织学风险模型，该模型在应用于皮肤肿瘤时已在黏膜头颈部鳞状细胞癌（HNSCC）中得到验证。在该模型中，包括最差浸润模式、淋巴细胞宿主反应和神经周围浸润在内的形态学变量可预测黏膜HNSCC的疾病复发、局部区域复发和总生存期。
在2007年7月至2012年7月的5年期间，从作者的数据库中识别出患有cSCC且已知有转移扩散的患者。2名组织病理学家分别对来自原发肿瘤的组织学标本进行分析。将评分与无转移扩散的T分期匹配对照标本进行比较。
识别出27例发生转移的cSCC患者。有淋巴结转移的个体中最差浸润模式（WPOI）评分显著更高（p = 0.02）。
定义为存在小肿瘤岛或肿瘤卫星灶的不良浸润模式可能是cSCC发生淋巴结转移的独立危险因素。这些肿瘤很难进行组织病理学研究，因为很难确定所选用于研究的正确原发灶。
