Definition of prognostic subgroups in the T3 stage of the eighth edition of the American Joint Committee on Cancer staging system for cutaneous squamous cell carcinoma: Tentative T3 stage subclassification

Conde-Ferreirós, Alberto; Corchete, Luis A.; Puebla-Tornero, Laura; Corchado-Cobos, Roberto; García-Sancha, Natalia; Román-Curto, Concépción; Cañueto, Javier

doi:10.1016/j.jaad.2020.03.088

Cited by 11 publications

(9 citation statements)

References 12 publications

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“…The AJCC-8 was published in 2017 and has improved upon the AJCC-7 system while demonstrating concordance with BWH stratification [60,62]. While the changes in AJCC-8 focused only on the head and neck region and included the most recent data available in describing independent prognostic factors in cSCC, there have already been publications identifying the limitations of this staging system [58,[60][61][62][63]. Can ˜ueto et al [60] used binary logistic regression to explore the significance of risk factors used in staging systems (comparing AJCC-7, AJCC-8, and BWH) to predict poor outcome events of 186 retrospectively collected H&N cSCCs.…”

Section: Current Tumor Staging Systems For Risk Stratificationmentioning

confidence: 99%

Current Methods and Caveats to Risk Factor Assessment in Cutaneous Squamous Cell Carcinoma (cSCC): A Narrative Review

Farberg

Fitzgerald²,

Ibrahim

et al. 2022

Dermatol Ther (Heidelb)

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Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer, and the number of deaths due to cSCC is estimated to be greater than the number attributed to melanoma. While the majority of cSCC tumors are resectable with clear margins by standard excision practices, some lesions exhibit high-risk factors for which there is evidence of their association with recurrence, metastasis, and disease-specific death. The most commonly used staging systems and guidelines in the USA for cSCC are based on these clinical and pathologic high-risk factors; however, these are limited in their ability to predict adverse events, thus posing a challenge for implementing risk-directed patient management. Since the development of local recurrence and/or metastasis has a profound impact on the survival of patients with cSCC, accurate identification of patients at high risk for poor outcomes is critical, potentially allowing for early and appropriate adjuvant therapy. This review summarizes the current cSCC literature with a focus on how differing clinical assessments within each of the five selected risk factors (perineural invasion, differentiation, depth of invasion, size, and location) can influence the evaluation of patient outcomes, along with summarizing the utility of staging and guidelines, and highlighting the potential for molecular tools to improve upon cSCC risk assessment.

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Section: Current Tumor Staging Systems For Risk Stratificationmentioning

confidence: 99%

Current Methods and Caveats to Risk Factor Assessment in Cutaneous Squamous Cell Carcinoma (cSCC): A Narrative Review

Farberg

Fitzgerald²,

Ibrahim

et al. 2022

Dermatol Ther (Heidelb)

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“…There was consensus among those who used AJCC and BWH that tumor stage ≥AJCC T3 or ≥BWH T2b should be considered high‐risk and radiologic imaging, SLNB, adjuvant radiation therapy, and increased follow‐up would be considered in these tumors. This threshold to consider adjuvant therapy is not surprising given the number of studies that have shown high poor outcomes rates in these tumors 21,22 . However, the exact clinical scenarios and management options that should be employed in these patients are uncertain.…”

Section: Discussionmentioning

confidence: 99%

“…This threshold to consider adjuvant therapy is not surprising given the number of studies that have shown high poor outcomes rates in these tumors. 21 , 22 However, the exact clinical scenarios and management options that should be employed in these patients are uncertain. Specifically, not all BWH T2b and AJCCT3 cases portend sufficient risk to warrant adjuvant therapy blindly, and data and guidelines vary regarding recurrence risk and management of this CSCC subset.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous squamous cell carcinoma staging may influence management in users: A survey study

et al. 2021

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Purpose This study aims to determine whether there is consensus regarding staging and management of cutaneous squamous cell carcinoma (CSCC) across the various specialties that manage this disease. Materials and Methods A survey regarding CSCC high‐risk features, staging, and management was created and emailed to cutaneous oncology experts including dermatology, head and neck surgery/surgical oncology, radiation oncology, and medical oncology. Results One hundred fifty‐six (46%) of 357 invited physicians completed the survey. Depth of invasion (92%), perineural invasion (99%), histologic differentiation (85%), and patient immunosuppression (90%) achieved consensus (>80%) as high‐risk features of CSCC. Dermatologists were more likely to also choose clinical tumor diameter (79% vs. 54%) and histology (99% vs. 66%) as a high‐risk feature. Dermatologists were also more likely to utilize the Brigham and Women's Hospital (BWH) staging system alone or in conjunction with American Joint Committee on Cancer (AJCC) (71%), whereas other cancer specialists (OCS) tend to use only AJCC (71%). Respondents considered AJCC T3 and higher (90%) and BWH T2b and higher (100%) to be high risk and when they consider radiologic imaging, sentinel lymph node biopsy, post‐operative radiation therapy, and increased follow‐up. Notably, a large number of respondents do not use staging systems or tumor stage to determine treatment options beyond surgery in high‐risk CSCC. Conclusion This survey study highlights areas of consensus and differences regarding the definition of high‐risk features of CSCC, staging approaches, and management patterns between dermatologists and OCS. High‐risk CSCC is defined as, but not limited to, BWH T2b and higher and AJCC T3 and higher, and these thresholds can be used to identify cases for which treatment beyond surgery may be considered. Dermatologists are more likely to utilize BWH staging, likely because BWH validation studies showing advantages over AJCC were published in dermatology journals and discussed at dermatology meetings. Additional data are necessary to develop a comprehensive risk‐based management approach for CSCC.

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“…21 There are alternative staging systems including the UICC8 (Union for International Cancer Control 8th edition) system, 50 the staging system by Breuninger et al, 51 the Tubingen system (using thickness, desmoplasia, immunosuppression), 52 and the Salamanca system (for a T3-AJCC8 stage subclassification). 53 However, risk stratification of high-risk cSCCs based on staging systems presents important limitations. Despite the improvement of AJCC8 over the previous AJCC7, there is still need of improvement in the risk stratification of cSCC.…”

Section: Prognostic Factors Of Progressionmentioning

confidence: 99%

Epidemiology of advanced cutaneous squamous cell carcinoma

Dessinioti

Pitoulias

Stratigos

2021

Acad Dermatol Venereol

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Cutaneous invasive squamous cell carcinoma (cSCC) most commonly presents as a typically indolent tumour with fiveyear cure rates of >90%. Advanced cSCC has been defined as locally advanced or metastatic (locoregional or distant) cSCC. The epidemiological data on advanced cSCC are rare due to underreporting or exclusion of cSCC from national cancer registries. Although the frequency of local recurrence has been reported, there is no clear evidence on the incidence or mortality of locally advanced cSCCs, e.g. locally infiltrating or locally recurrent cSCCs that are not further amenable to curative surgery or radiotherapy. This gap of knowledge on the epidemiology of locally advanced cSCC, highlights the need for standardisation in defining and reporting both locally advanced and metastatic cSCC. Even though metastatic cSCCs are a small part of cSCCs (3%-5%), their aggressive characteristics contribute to significant morbidity, higher mortality and are those likely to require systemic treatments. Locally recurrent and metastatic cSCC may occur more frequently in high-risk cSCCs (up to 35%). The site of metastasis involves in the vast majority the regional lymph nodes, with the head and neck lymph nodes or parotid most commonly affected. Metastasis occurs mostly within 2-3 years of the primary cSCC diagnosis. The knowledge of the incidence and prognosis of advanced cSCC and the risk stratification of patients, who may progress to advanced cSCC, emerge as pressing research areas with important implications for cost-efficiency planning and optimisation of patient care.

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Definition of prognostic subgroups in the T3 stage of the eighth edition of the American Joint Committee on Cancer staging system for cutaneous squamous cell carcinoma: Tentative T3 stage subclassification

Cited by 11 publications

References 12 publications

Current Methods and Caveats to Risk Factor Assessment in Cutaneous Squamous Cell Carcinoma (cSCC): A Narrative Review

Current Methods and Caveats to Risk Factor Assessment in Cutaneous Squamous Cell Carcinoma (cSCC): A Narrative Review

Cutaneous squamous cell carcinoma staging may influence management in users: A survey study

Epidemiology of advanced cutaneous squamous cell carcinoma

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