Eigentler Thomas K, Leiter Ulrike, Häfner Hans-Martin, Garbe Claus, Röcken Martin, Breuninger Helmut
Department of Dermatology, University Hospital Tübingen, Tübingen, Germany.
Department of Dermatology, University Hospital Tübingen, Tübingen, Germany.
J Invest Dermatol. 2017 Nov;137(11):2309-2315. doi: 10.1016/j.jid.2017.06.025. Epub 2017 Jul 21.
Cutaneous squamous cell carcinoma (cSCC) is an increasing health burden in white populations. We prospectively assessed risk factors for tumor-specific and overall survival in 1,434 patients who underwent surgery for cSCC between January 24, 2005, and May 29, 2015. A total of 2,149 invasive cSCCs were analyzed. Univariate and multivariate survival analyses included tumor thickness, horizontal size, body site, histological differentiation, desmoplastic growth, history of multiple cSCCs, and immunosuppression. The primary endpoint was time to tumor-specific death. During a median follow-up period of 36.5 months (range = 0-137 months), 515 patients died; 40 because of cSCC (2.8%). Of those, 12 died because of visceral metastases and 28 because of tumor growth by local infiltration. On multivariate analyses, prognostic factors for tumor-specific survival were increased vertical tumor thickness (hazard ratio = 6.73; 95% confidence interval = 3.47-13.08; P < 0.0001), desmoplastic growth (hazard ratio = 4.14; 95% confidence interval = 2.68-9.83; P < 0.0001), and immunosuppression (hazard ratio = 2.07; 95% confidence interval = 1.04-4.12; P = 0.039). Defining a point list out of those factors and grouping them into four cohorts resulted in comprehensively separating survival curves (P < 0.001). Using a cut-off for tumor thickness of 6 mm or greater, the presence of desmoplastic growth and immunosuppression identifies patients at high risk for tumor-specific death.
皮肤鳞状细胞癌（cSCC）对白人人群的健康负担日益加重。我们对2005年1月24日至2015年5月29日期间接受cSCC手术的1434例患者的肿瘤特异性生存和总生存风险因素进行了前瞻性评估。共分析了2149例浸润性cSCC。单因素和多因素生存分析包括肿瘤厚度、水平大小、身体部位、组织学分化、促纤维组织增生性生长、多发cSCC病史和免疫抑制。主要终点是肿瘤特异性死亡时间。在中位随访期36.5个月（范围 = 0 - 137个月）内，515例患者死亡；40例死于cSCC（2.8%）。其中，12例死于内脏转移，28例死于肿瘤局部浸润性生长。多因素分析显示，肿瘤特异性生存的预后因素包括垂直肿瘤厚度增加（风险比 = 6.73；95%置信区间 = 3.47 - 13.08；P < 0.0001）、促纤维组织增生性生长（风险比 = 4.14；95%置信区间 = 2.68 - 9.83；P < 0.0001）和免疫抑制（风险比 = 2.07；95%置信区间 = 1.04 - 4.12；P = 0.039）。根据这些因素定义一个点列表并将其分为四个队列，可全面分离生存曲线（P < 0.001）。使用肿瘤厚度≥6 mm的临界值、促纤维组织增生性生长的存在和免疫抑制可识别出肿瘤特异性死亡的高危患者。
