High-risk prognostic tumor features of squamous cell carcinomas in organ transplant recipients compared with the general population
Pandeya, N. Isbel, N. Campbell, S. Chambers, D. C. Hopkins, P. Soyer, H. P. Jiyad, Z. Plasmeijer, E. I. Whiteman, D. C. Olsen, C. M.
Pandeya, N.
Isbel, N.
Campbell, S.
Chambers, D. C.
Hopkins, P.
Soyer, H. P.
Jiyad, Z.
Plasmeijer, E. I.
Whiteman, D. C.
Olsen, C. M.
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Abstract
Importance: The extent to which major high-risk features of squamous cell carcinomas (SCCs) in organ transplant recipients (OTRs) differ from SCCs in the general population is not known.
Objective: To quantify the relative frequency of perineural invasion, invasion below the dermis, lack of cellular differentiation, and tumor diameter greater than 20 mm in SCCs in OTRs and the general population, by anatomic site.
Design, setting, and participants: This dual-cohort study in Queensland, Australia, included a cohort of OTRs at high risk of skin cancer ascertained from 2012 to 2015 (Skin Tumours in Allograft Recipients [STAR] study) and a population-based cohort ascertained from 2011 (QSkin Sun and Health Study). The STAR study comprised population-based lung transplant recipients and kidney and liver transplant recipients at high risk of skin cancer recruited from tertiary centers and diagnosed with histopathologically confirmed SCC from 2012 to 2015. The QSkin participants were recruited from Queensland's general adult population, and primary SCCs diagnosed from 2012 to 2015 were ascertained through Medicare (national health insurance scheme) and linked with histopathology records. Data analysis was performed from July 2022 to April 2023.
Main outcomes and measures: Prevalence ratio (PR) of head/neck location, perineural invasion, tumor invasion to/beyond subcutaneous fat, poor cellular differentiation, and tumor diameter greater than 20 mm among SCCs in OTRs vs the general population.
Results: There were 741 SCCs excised from 191 OTRs (median [IQR] age, 62.7 [56.7-67.1] years; 149 [78.0%] male) and 2558 SCCs from 1507 persons in the general population (median [IQR] age, 63.7 [58.0-68.8] years; 955 [63.4%] male). The SCCs developed most frequently on the head/neck in OTRs (285, 38.6%), but on arms/hands in the general population (896, 35.2%) (P < .001). After adjusting for age and sex, perineural invasion was more than twice as common in OTRs as in population cases (PR, 2.37; 95% CI, 1.70-3.30), as was invasion to/beyond subcutaneous fat (PR, 2.37; 95% CI, 1.78-3.14). Poorly vs well-differentiated SCCs were more than 3-fold more common in OTRs (PR, 3.45; 95% CI, 2.53-4.71), and prevalence of tumors greater than 20 mm vs 20 mm or smaller was moderately higher in OTRs (PR, 1.52; 95% CI, 1.08-2.12).
Conclusions and relevance: In this dual-cohort study, SCCs in OTRs had significantly worse prognostic features than SCCs in the general population, reinforcing the necessity of early diagnosis and definitive management of SCCs in OTRs.
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Date
2023
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Article
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Pandeya N, Isbel N, Campbell S, Chambers DC, Hopkins P, Soyer HP, et al. High-risk Prognostic Tumor Features of Squamous Cell Carcinomas in Organ Transplant Recipients Compared With the General Population. JAMA Dermatol. 2023 Jun 14. PubMed PMID: 37314794. Pubmed Central PMCID: PMC10267841 and Medical Research Council of Australia (NHMRC) MRFF Next Generation Clinical Researchers Program Practitioner Fellowship (APP1137127), payments to University of Queensland (UQ) (medical consulting) from Canfield Scientific and Blaze Biosciences, serving as a medical adviser (no financial compensation) for First Derm, and being a shareholder of e-derm-consult GmbH and MoleMap NZ outside the submitted work; in addition, Dr Soyer had a patent for PCT/AU/2013/000394 and US 9,662,095 B2 licensed to Trajan Scientific and Medical Via Uniquest, UQ’s main commercialization company. Dr Whiteman reported grants from NHMRC (fellowship for salary and competitive grants to support data collection and analysis) during the conduct of the study; and personal fees from Pierre Fabre (speaker fees for conference presentation) outside the submitted work. Dr Olsen reported grants from NHMRC (APP1073898; APP1063061; APP1185416) outside the submitted work. No other disclosures were reported. Epub 2023/06/14. eng.