Brigham and Women's Hospital tumor classification system for basal cell carcinoma identifies patients with risk of metastasis and death - 03/04/21

Doi : 10.1016/j.jaad.2021.01.052

Frederick C. Morgan, BSPH ^a, Emily Stamell Ruiz, MD, MPH ^a, Pritesh S. Karia, MPH ^a,^b, Robert J. Besaw, MPH ^a, Victor A. Neel, MD, PhD ^c, Chrysalyne D. Schmults, MD, MSCE ^a,^⁎
^a Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
^b Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
^c Department of Dermatology, Brown University, Providence, Rhode Island

^∗Correspondence to: Chrysalyne D. Schmults, MD, MSCE, Department of Dermatology, Brigham and Women's Hospital, 1153 Centre St, Suite 4J, Boston, MA 02130.Department of DermatologyBrigham and Women's Hospital1153 Centre StSuite 4JBostonMA02130

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Abstract

Background

Despite approximately 4400 locally advanced US cases annually, high-stage basal cell carcinoma (BCC) is ill-defined.

Objective

To develop a tumor (T) staging system for BCC that will predict metastasis/death and compare its performance with that of the American Joint Committee on Cancer 8th edition (AJCC8) T-staging system.

Methods

Brigham and Women's Hospital (BWH) T staging was developed from a previously published nested cohort of 488 primary BCCs. Tumors were staged via BWH and AJCC8 T-staging systems, and predictions of metastasis and/or death were compared.

Results

The BWH and AJCC8 T-staging systems both captured all metastases/deaths in high T stages (BWH, T2; AJCC8, T3/T4). BWH T2 included 54% fewer cases ≥2 cm than AJCC8 T3/T4. BWH had a higher specificity (0.92 vs 0.80; P < .001) and positive predictive value (24% vs 11%, P < .001) for identifying cases at risk for metastasis/death, and the C-statistic was superior for BWH (P < .001). The BWH T2 10-year cumulative incidence of metastasis/death was 37% (95% confidence interval, 21%-60%).

Limitations

Two-center cohort.

Conclusions

BWH and AJCC 8 BCC staging both capture all metastases and deaths in the upper stages. However, BWH staging does so in half the number of cases, thus minimizing inappropriate up-staging. The risk of metastasis or death in BWH T2 BCC is sufficient to warrant surveillance for recurrence and clinical trials of adjuvant therapy.

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Key words : basal cell carcinoma, death, metastasis, outcomes, recurrence, risk factors, staging

Abbreviations used : AJCC 8, BCC, BWH, CI, M/D, NCCN, NPV, PPV, SCC

Plan

Methods

Results

Discussion

	Funding sources: Supported by Genentech, Inc, which provided an unrestricted grant for the conduct of this study.
	IRB approval status: The Partners Human Research Committee approved this study.
	Reprints not available from the authors.