Petter Gjersvik, MD, PhD

Credit: Oslo University Hospital

Organ transplant recipients (OTRs) with cutaneous squamous cell carcinoma (cSCC) have substantially higher rates of metastasis, a second cSCC, and mortality from cSCC compared to cSCC patients who did not receive organ transplants, according to new findings.¹

These findings were the results of a study in Norway expanding upon limited current literature assessing the risk of disease-specific death resulting from cSCC, specifically for immunosuppressed and immunocompetent individuals.²

To address this gap in understanding, the team conducted the study and the research was authored by Petter Gjersvik, MD, PhD, from the Department of Dermatology at Oslo University Hospital in Norway.

“To increase knowledge on the epidemiology and clinical course of cSCC, we studied the occurrence of a second cSCC, metastasis, and death from cSCC in non-OTRs and OTRs, using population-based data from national registries that span more than 5 decades,” Gjersvik and colleagues wrote.

Background and Findings

The investigators note that in Norway, reporting all cancer cases, excluding basal cell carcinoma, and cancer metastasis to the national Cancer Registry is mandatory for medical doctors and pathology laboratories. For the cohort study, the team used individuals who had been diagnosed with at least 1 histologically verified cSCC between January 1, 1968, and December 31, 2020, excluding those under 18 years old at the time of diagnosis.

The in situ tumors (cSCC in situ) were not considered by the team. The investigators categorized tumor locations, including neck and trunk, head, ear, and face (including the eyelid), perineum and perianal, lower limbs, upper limbs, multiple localizations, and unspecified location.

The Cancer Registry of Norway was known to provide information on second cSCC and metastasis. Second tumors and metastases were noted as being reported by pathology laboratories, with some additional reports collected by clinicians. Vital status and cause of death were gathered by the investigators from the National Population Register and the Norwegian Cause of Death Registry.

Organ transplant recipients with a minimum of a single cSCC tumor were identified by the research team by linking to organ-specific national registries. Patients with cSCC before their first organ transplant were excluded by the team.

The primary outcomes which the investigators determined were second cSCC, metastasis, and death as a result of cSCC. They defined a second cSCC based upon clinical notification of multiple tumors or registration of a second cSCC at the time of follow-up.

The investigators noted that metastasis included regional lymph node and distant metastases and it was also registered at the time of patient diagnosis or at the time of follow-up. Death from cSCC includes deaths with cSCC as the underlying cause.

Overall, 1208 OTRs and 46,784 non-OTRs were included by the investigators in their research. The research team reported that the incidence of a second cSCC per 1000 person-years was found to be 30.9 for non-OTRs and 250.6 for OTRs, with OTRs notably showing a 4.3-fold higher rate in the team’s adjusted analysis.

The team noted that metastasis rates per 1000 person-years were found to be 2.8 among non-OTRs and 4.8 among OTRs, with OTRs showing a 1.5-fold higher rate in the investigators’ adjusted analysis. Among the observed 30,451 deaths, they noted that 29,895 were from causes other than cSCC.

The investigators added that deaths from cSCC were found to have happened in 1.1% of non-OTRs and 3.3% of OTRs. The rate of mortality resulting from cSCC per 1000 person-years was also noted as being 1.7 in non-OTRs and 5.4 in OTRs, with OTRs showing a 5.5-fold higher rate in the analysis.

“Our results have implications for the clinical follow-up of patients with cSCC,” they wrote. “With the high volume of patients with cSCC, skin cancer services should be organized so that patients receive individualized and optimal care without an unmanageably high number of consultations and referrals.”

References

1. ^{Gjersvik P, Falk RS, Roscher I, et al. Rates of Second Tumor, Metastasis, and Death From Cutaneous Squamous Cell Carcinoma in Patients With and Without Transplant-Associated Immunosuppression. JAMA Dermatol. Published online July 19, 2023. doi:10.1001/jamadermatol.2023.2029.}
2. ^{Eigentler TK, Dietz K, Leiter U, Häfner HM, Breuninger H. What causes the death of patients with cutaneous squamous cell carcinoma? a prospective analysis in 1400 patients. Eur J Cancer. 2022;172:182-190. doi:10.1016/j.ejca.2022.05.043.}