Retrospective, Registry-based, Cohort Investigation of Clinical Outcomes in Patients with Cutaneous Squamous Cell Carcinoma and Basal Cell Carcinoma in Finland
Keywords:cutaneous squamous cell carcinoma, basal cell carcinoma, skin cancer, real-world evidence, real world data, cohort study
Most cases of keratinocyte cancer can be treated effectively with surgery. However, survival is reduced in patients with advanced disease. This retrospective cohort study evaluated overall survival of patients with invasive keratinocyte cancers, and high-risk features for progression of the disease and mortality in Finnish patients in a real-world setting. A total of 43,143 patients with keratinocyte cancer types of basal cell carcinoma and 10,380 with cutaneous squamous cell carcinoma were identified nationwide. More detailed patient records were available for a subset of patients (basal cell carcinoma n = 5,020 and cutaneous squamous cell carcinoma n = 1,482) from a regional database. Fifty percent of patients with advanced cutaneous squamous cell carcinoma died approximately 4.5 years after diagnosis. Multivariable models suggested that risk factors for keratinocyte cancer progression were male sex, presence of comorbidities, immunosuppression, and pre-cancerous lesions, while risk factors for disease-specific mortality were advanced disease stage with immunosuppression, other malignancies, and consecutive surgical excisions. These results suggest that identifying patient and tumour factors associated with poor disease outcome could be important when determining appropriate treatment and follow-up; however, further studies are necessary.
Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol 2012; 166: 1069-1080.
Leiter U, Eigentler T, Garbe C. Epidemiology of skin cancer. Sunlight, vitamin D and skin cancer, New York, NY: Springer New York; 2014, p. 120-140.
Trakatelli M, Ulrich C, del Marmol V, Euvrard S, Stockfleth E, Abeni D. Epidemiology of nonmelanoma skin cancer (NMSC) in Europe: accurate and comparable data are needed for effective public health monitoring and interventions. Br J Dermatol 2007; 156: 1-7.
Pitkäniemi J, Malila N, Tanskanen T, Degerlund H, Heikkinen S, Seppä K. Syöpä 2019. Cancer in Finland. Helsinki: Suomen Syöpäyhdistys; 2021.
Albert A, Knoll MA, Conti JA, Zbar RIS. Non-melanoma skin cancers in the older patient. Curr Oncol Rep 2019; 21: 79.
Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, Bataille V, Bastholt L, et al. European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: part 1. epidemiology, diagnostics and prevention. Eur J Cancer 2020; 128: 60-82.
Gordon LG, Rowell D. Health system costs of skin cancer and cost-effectiveness of skin cancer prevention and screening: a systematic review. Eur J Cancer Prev 2015; 24: 141-149.
Apalla Z, Lallas A, Sotiriou E, Lazaridou E, Ioannides D. Epidemiological trends in skin cancer. Dermatol Pract Concept 2017; 7: 1-6.
Gordon LG, Rowell D. Health system costs of skin cancer and cost-effectiveness of skin cancer prevention and screening: a systematic review. Eur J Cancer Prevent 2015; 24: 141-149.
Fahradyan A, Howell A, Wolfswinkel E, Tsuha M, Sheth P, Wong A. Updates on the management of non-melanoma skin cancer (NMSC). Healthcare 2017; 5: 82.
McCusker M, Basset-Seguin N, Dummer R, Lewis K, Schadendorf D, Sekulic A, et al. Metastatic basal cell carcinoma: prognosis dependent on anatomic site and spread of disease. Eur J Cancer 2014; 50: 774-783.
Pitkänen S, Jeskanen L, Ylitalo L. [Basal cell carcinoma, squamous cell carcinoma and premalignant skin lesions - how to treat?]. Duodecim 2014; 130: 643-653 (in Finnish).
NCCN clinical guidelines for squamous cell skin cancer 2021. [accessed January 12, 2021]. Available from www.nccn.org/professionals/physician_gls/pdf/squamous.pdf.
Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, Bataille V, Bastholt L, et al. European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 2. Treatment. Eur J Cancer 2020; 128: 83-102.
Hillen U, Leiter U, Haase S, Kaufmann R, Becker J, Gutzmer R, et al. Advanced cutaneous squamous cell carcinoma: a retrospective analysis of patient profiles and treatment patterns - results of a non-interventional study of the DeCOG. Eur J Cancer 2018; 96: 34-43.
Dummer R, Guminksi A, Gutzmer R, Lear JT, Lewis KD, Chang ALS, et al. Long-term efficacy and safety of sonidegib in patients with advanced basal cell carcinoma: 42-month analysis of the phase II randomized, double-blind BOLT study. Br J Dermatol 2020; 182: 1369-1378.
for the ERIVANCE BCC Investigators, Sekulic A, Migden MR, Basset-Seguin N, Garbe C, Gesierich A, et al. Long-term safety and efficacy of vismodegib in patients with advanced basal cell carcinoma: final update of the pivotal ERIVANCE BCC study. BMC Cancer 2017; 17: 332.
Migden MR, Rischin D, Schmults CD, Guminski A, Hauschild A, Lewis KD, et al. PD-1 blockade with cemiplimab in advanced cutaneous squamous-cell carcinoma. N Engl J Med 2018; 379: 341-351.
Grob J-J, Gonzalez R, Basset-Seguin N, Vornicova O, Schachter J, Joshi A, et al. Pembrolizumab monotherapy for recurrent or metastatic cutaneous squamous cell carcinoma: a single-arm phase II Trial (KEYNOTE-629). JCO 2020; 38: 2916-2925.
Lansbury L, Bath-Hextall F, Perkins W, Stanton W, Leonardi-Bee J. Interventions for non-metastatic squamous cell carcinoma of the skin: systematic review and pooled analysis of observational studies. BMJ 2013; 347: f6153-f6153.
Sahovaler A, Krishnan RJ, Yeh DH, Zhou Q, Palma D, Fung K, et al. Outcomes of cutaneous squamous cell carcinoma in the head and neck region with regional lymph node metastasis: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg 2019; 145: 352.
Sun L, Chin R-I, Gastman B, Thorstad W, Yom SS, Reddy CA, et al. Association of disease recurrence with survival outcomes in patients with cutaneous squamous cell carcinoma of the head and neck treated with multimodality therapy. JAMA Dermatol 2019; 155: 442.
Knuutila J, Riihilä P, Kurki S, Nissinen L, Kähäri V-M. Risk factors and prognosis for metastatic cutaneous squamous cell carcinoma: a cohort study. Acta Derm Venereol 2020; 100: adv00266.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383.
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. Null 1958; 53: 457-481.
R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2018.
Kim JYS, Kozlow JH, Mittal B, Moyer J, Olencki T, Rodgers P, et al. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol 2018; 78: 540-559.
Peris K, Piccerillo A, Del Regno L, Di Stefani A. Treatment approaches of advanced cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol 2022; 36: 19-22.
How to Cite
Copyright (c) 2022 Samuli Tuominen, Liisa Ukkola-Vuoti, Pilvi Riihilä, Jaakko S. Knuutila, Veli-Matti Kähäri, Mariann Lassenius, Tuuli Ranki, Katariina Pousar, Lotta Vassilev, Sauli Vuoti, Kalle Mattila
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.