Immunosuppression is associated with an increased risk of distant metastases in high-risk cutaneous squamous cell carcinoma: A retrospective cohort study

Abstract

[EN]Cutaneous squamous cell carcinoma (CSCC) is the second most frequent cancer in humans, and it can be both locally invasive and metastatic to distant sites. Despite distant metastases (DM) being rare in CSCC, some patients do develop DM. Immunosuppression (IS) is a risk factor for CSCC. Several clinical practice guidelines consider IS to be a high-risk feature for recurrence in CSCC, but it is currently excluded from most popular staging systems. Some recent studies, including a meta-analysis,1 have explored the prognostic impact of IS in CSCC.1,2 However, there is still certain lack of knowledge on IS impact on DM as a separate outcome instead of pooling it with nodal metastases given the very small number of studies with small series in which DM was evaluated.1 We evaluated a cohort of patients diagnosed with CSCC between 2010 and 2019 at the University Hospital of Salamanca, Spain. CSCCs were selected when 1 or more of the following risk factors of poor prognosis were present: tumor diameter≥2 cm, thickness>6 mm, perineural invasion, poor differentiation, lymphovascular invasion (LVI), invasion beyond the subcutaneous fat, desmoplasia, tumor budding, and IS. When more than 1 CSCC was diagnosed in the same patient, that supposing the greatest risk was considered. A cohort of 781 high-risk CSCCs was retrieved (218 in immunosuppressed). In this cohort, there were 100 local recurrences, 97 nodal metastases, 30 DM, and 64 patients died from CSCC.