Risk factors for lymph node metastasis in cutaneous squamous cell carcinoma: a long-term retrospective study of Japanese
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ORIGINAL ARTICLE
Risk factors for lymph node metastasis in cutaneous squamous cell carcinoma: a long‑term retrospective study of Japanese patients Yuki Saito1,2 · Hiroki Fujikawa2 · Sumiko Takatsuka1 · Riichiro Abe2 · Tatsuya Takenouchi1 Received: 15 July 2020 / Accepted: 29 October 2020 © Japan Society of Clinical Oncology 2020
Abstract Background 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. Methods 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). Results Tumor diameter > 2 cm (p 6 mm (p 6 mm Depth of invasion Dermis Beyond subcutaneous fat Degree of differentiation Well Moderate Poor N/A Infiltrative growth pattern a
Table 1 (continued) No. (%) 310 (57.4) 230 (42.5) 80 (27–104) 312 (57.8) 11 (2.0) 35 (6.4) 76 (14.1) 106 (19.6) 247 (45.7) 154 (28.5) 110 (20.4) 7 (1.3) 22 (4.1)
Characteristic
No. (%)
b c N/A Initial therapy Surgical therapy Wide local excision alone Wide local excision + lymph node dissection Radiotherapy Chemotherapy Palliative therapy alone
203 (37.6) 152 (28.1) 60 (11.1) 535 (99) 519 16 4 (0.7) 6 (1.1) 5 (0.9)
a
UICC-8 eighth version of the Union for International Cancer Control classification
250 (46.3) 160 (29.6) 106 (19.6) 1 (0.2) 23 (4.3) 496 (91.9) 17 (3.1) 5 (0.9) 1 (0.2) 21 (3.9) 517 (95.7) 2 (0.4) 21 (3.9) 2 cm 309 (63.3) 179 (36.7) 3.8 mm 344 (72.4) 131 (27.6) 328 (69.1) 147 (30.9) 186 (34.5) 92 (17) 190 (35.2) 72 (13.3) 125 (23.2)
Fig. 1 Kaplan–Meier estimates of disease-specific survival among the 540 patients with cutaneous squamous cell carcinoma
metastasis group [99% (95% CI 97.1–99.6) and 99% (95% CI: 97.1–99.6), respectively] (p 6 mm Depth of invasion Dermis Beyond subcutaneous fat Degree of differentiation Well/moderate Poor Infiltrative growth pattern a/b c a
HR Hazard ratio
b
CI confidence interval
HRa [95% CIb]
p value
Reference 2.9 [1.4–6.2]
– 0.006
Reference 2.9 [1.3–6.4]
– 0.007
Reference 2.3 [1.0–5.1]
– 0.045
Reference 1.5 [0.8–2.8]
– 0.240
Reference 1.8 [0.9–3.7]
– 0.089
node metastasis in Asian CSCC patients is an important clinical aim. Japanese dermato-oncologists basically follow the UICC staging system for the management of CSCC
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