Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Case Western Reserve University School of Medicine, Cleveland, Ohio.
Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Am Acad Dermatol. 2022 Jun;86(6):1301-1308. doi: 10.1016/j.jaad.2021.11.046. Epub 2021 Dec 2.
Although most of the poor outcomes with cutaneous squamous cell carcinoma (CSCC) occur in high-stage tumors, 26% of nodal metastases and 8% of disease-specific deaths develop in Brigham and Women's Hospital (BWH) T2a tumors.
To determine risk factors associated with poor outcomes (nodal metastasis, distant metastases, and disease-specific deaths) in BWH T2a CSCC.
A 17-year retrospective multi-institutional cohort study of primary CSCC BWH T2a tumors. A predictive model based on tumor characteristics was developed to identify those at higher risk of poor outcomes.
Presence of 1 major criterion (primary tumor diameter ≥40 mm, invasion depth beyond subcutaneous fat, poor differentiation, or large-caliber perineural invasion) and ≥ 1 minor criterion (invasion depth in subcutaneous fat, moderate differentiation, small-caliber perineural invasion, or lymphovascular invasion) was most predictive of developing poor outcomes (area under the curve, 0.53; C-statistic, 0.60). This model has a sensitivity of 7.7%, specificity of 97.4%, and a positive and negative predictive value of 33.3% and 86.1%, respectively. The 5-year cumulative incidence of poor outcomes in these tumors is 8.0% (95% CI, 5.1-13.7) compared to 2.8% (95% CI, 1.9-4.1) in other T2a tumors (sub-hazard ratio, 3.0; 95% CI, 1.5-5.8).
Multi-institutional cohort study was not externally validated.
BWH T2a-high CSCCs have an 8% chance of developing poor outcomes.
尽管皮肤鳞状细胞癌（CSCC）的大多数不良预后发生在高分期肿瘤中，但 26%的淋巴结转移和 8%的疾病特异性死亡发生在布里格姆妇女医院（BWH）T2a 肿瘤中。
确定与 BWH T2a CSCC 不良预后（淋巴结转移、远处转移和疾病特异性死亡）相关的危险因素。
对 BWH T2a 原发性 CSCC 进行了一项为期 17 年的回顾性多机构队列研究。基于肿瘤特征开发了一种预测模型，以确定那些具有更高不良预后风险的患者。
存在 1 个主要标准（原发性肿瘤直径≥40mm、浸润深度超过皮下脂肪、分化差或大直径神经周围浸润）和≥1 个次要标准（皮下脂肪浸润、中等分化、小直径神经周围浸润或淋巴血管浸润）与发生不良预后最相关（曲线下面积为 0.53；C 统计量为 0.60）。该模型的灵敏度为 7.7%，特异性为 97.4%，阳性预测值和阴性预测值分别为 33.3%和 86.1%。这些肿瘤的 5 年不良预后累积发生率为 8.0%（95%CI，5.1-13.7），而其他 T2a 肿瘤为 2.8%（95%CI，1.9-4.1）（亚危险比，3.0；95%CI，1.5-5.8）。
多机构队列研究未进行外部验证。
BWH T2a 高 CSCC 发生不良预后的概率为 8%。
