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 - 19/07/20

Doi : 10.1016/j.jaad.2020.03.088

Alberto Conde-Ferreirós, MD ^a, Luis Antonio Corchete, MSc, PhD ^b,^c,^d, Laura Puebla-Tornero, MD ^a, Roberto Corchado-Cobos, MSc ^e, Natalia García-Sancha, MSc ^e, Concepción Román-Curto, MD, PhD ^a,^b, Javier Cañueto, MD, PhD ^a,^b,^e,^⁎
^a Departamento de Dermatología, Hospital Universitario de Salamanca, Salamanca, Spain
^b Instituto de Investigación Biomédica de Salamanca, Hospital Universitario de Salamanca, Salamanca, Spain
^c Instituto de Biologia Molecular y Celular del Cancer (IBMCC) - Consejo Superior de Investigaciones Científicas (CSIC), Laboratory 12, Campus Miguel de Unamuno, Salamanca, Spain
^d Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
^e IBMCC-CSIC, Laboratory 7, Campus Miguel de Unamuno, Salamanca, Spain

^∗Correspondence to: Javier Cañueto, MD, PhD, Department of Dermatology, Complejo Asistencial Universitario de Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain.Department of DermatologyComplejo Asistencial Universitario de SalamancaPaseo San Vicente 58-182Salamanca37007Spain

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Abstract

Background

Although the eighth edition of the American Joint Committee on Cancer staging system (AJCC8) provides improved prognosis stratification of cutaneous squamous cell carcinoma (CSCC) over AJCC7, T3 has a variable prognosis.

Objective

To define prognostic subgroups in T3-AJCC8 CSCC.

Methods

Retrospective cohort study of 196 primary T3-AJCC8 CSCCs. We conducted multidimensional scaling analysis using the 6 risk factors that define T3 CSCCs. The prognoses of the groups obtained were analyzed by means of competing risk analysis.

Results

Group 1 was characterized by a tumor thickness greater than 6 mm (without invasion beyond the subcutaneous fat), alone or in combination with a tumor width of at least 4 cm. Group 2 was characterized by the presence of either invasion beyond the subcutaneous fat or by the involvement of nerves (≥0.1 mm, or deeper than the dermis). Group 3 was characterized by the combination of both T3b risk factors, or of 3 or more risk factors. Group 3 (tentatively named T3c) patients had the worst prognosis for disease-specific poor outcome events and major events, Group 2 (T3b) had intermediate risk, and Group 1 (T3a) had the best prognosis (disease-specific poor outcome events: hazard ratio [HR], 1.94; P = .00009; major events: HR, 2.55; P = .00001; disease-specific death: HR, 10.25; P = .0009).

Limitations

Retrospective study.

Conclusions

There is statistically significant evidence that T3-AJCC8 may be classified into distinct prognostic subgroups.

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Key words : AJCC8, cutaneous squamous cell carcinoma, prognosis, skin cancer, staging

Abbreviations used : AJCC7, AJCC8, BIC, CSH, CSCC, DSPO, HR, ME

Plan

Patients and methods

Patients and variables

Statistical analysis

Results

Cohort description

Stratification of AJCC8 T3 tumors

Prognoses of the AJCC8 T3 subgroups

Discussion

	Reprints not available from the authors.
	Dr Conde-Ferreirós and Mr Corchete are cofirst authors.
	Funding sources: Dr Cañueto is partially supported by the grants PI18/000587 (Instituto de Salud Carlos III, cofinanciación Fondo Europeo de Desarrollo Regional [FEDER]) and GRS 1835/A/18 (Gerencia Regional de Salud de Castilla y León), and by the Programa de Intensificación de la Actividad Investigadora de la Gerencia Regional de Salud de Castilla y León (INT/M/10/19), Spain.
	Conflicts of interest: None disclosed.
	IRB approval status: Not applicable.