Department of Dermatology, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Chuo-ku, Niigata, 951-8566, Japan.
Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Int J Clin Oncol. 2021 Mar;26(3):606-612. doi: 10.1007/s10147-020-01830-7. Epub 2020 Nov 11.
Cutaneous squamous cell carcinoma (CSCC) is one of the most common skin cancers. Prognosis is favorable following surgical resection of early-stage disease, but the management of the metastatic disease is challenging. Several prognostic risk factors have been described in the American Joint Committee on Cancer/the Union for International Cancer Control (UICC) 8th edition staging and the Brigham and Women's Hospital T classification system. However, their clinical validity in Asian populations is unclear because of racial differences in the clinical characteristics of CSCC. This study aimed to identify factors that could predict lymph node metastasis in Asian patients.
This retrospective single-center study evaluated 540 patients with primary CSCC between 1989 and 2013. Five factors were evaluated for their ability to predict lymph node metastasis: maximum tumor diameter, tumor thickness, depth of invasion, degree of differentiation, and infiltrative growth pattern (INF).
Tumor diameter > 2 cm (p < 0.0001), tumor thickness > 6 mm (p < 0.0001), invasion beyond the subcutaneous fat (p < 0.0001), poor differentiation (p = 0.042), and INFc infiltration (p < 0.0001) were associated with lymph node metastasis in the univariate analyses. In the multivariate analysis, lymph node metastasis was independently associated with tumor size > 2 cm [hazard ratio (HR) 2.9, 95% confidence interval (CI) 1.4-6.2; p = 0.006], tumor thickness > 6.0 mm (HR 2.9, 95% CI 1.3-6.4; p = 0.007), and invasion beyond the subcutaneous fat (HR 2.3, 95% CI 1.0-5.1; p = 0.045).
Larger tumor diameter, greater tumor thickness, and deeper invasion included in the UICC T classification system are associated with increased risks of lymph node metastasis from CSCC in Japanese patients.
皮肤鳞状细胞癌（CSCC）是最常见的皮肤癌之一。早期疾病经手术切除后预后良好，但转移性疾病的治疗具有挑战性。美国癌症联合委员会/国际癌症控制联盟（UICC）第 8 版分期和布莱根妇女医院 T 分类系统已经描述了几种预后危险因素。然而，由于 CSCC 的临床特征在亚洲人群中存在种族差异，因此这些危险因素在亚洲人群中的临床有效性尚不清楚。本研究旨在确定可预测亚洲患者淋巴结转移的因素。
本回顾性单中心研究评估了 1989 年至 2013 年间 540 例原发性 CSCC 患者。评估了 5 个因素对预测淋巴结转移的能力：最大肿瘤直径、肿瘤厚度、浸润深度、分化程度和浸润生长模式（INF）。
肿瘤直径＞2cm（p＜0.0001）、肿瘤厚度＞6mm（p＜0.0001）、浸润超过皮下脂肪（p＜0.0001）、分化不良（p=0.042）和 INFc 浸润（p＜0.0001）与单因素分析中的淋巴结转移相关。多因素分析中，淋巴结转移与肿瘤大小＞2cm[风险比（HR）2.9，95%置信区间（CI）1.4-6.2；p=0.006]、肿瘤厚度＞6.0mm（HR 2.9，95% CI 1.3-6.4；p=0.007）和浸润超过皮下脂肪（HR 2.3，95% CI 1.0-5.1；p=0.045）独立相关。
UICC T 分类系统中包含的更大肿瘤直径、更大肿瘤厚度和更深的浸润与日本患者 CSCC 淋巴结转移风险增加相关。
