Aggressive Squamous Cell Carcinoma in Organ Transplant Recipients

Abstract

Importance: Squamous cell carcinoma (SCC) is the most frequent malignant neoplasm found in solid organ transplant recipients and is associated with a more aggressive disease course and higher risk of metastasis and death than in the general population.

Objectives: To report the clinicopathologic features of and identify factors associated with aggressive SCC in solid organ transplant recipients.

Methods: This retrospective multicentric case series included 51 patients who underwent solid organ transplantation and were found to have aggressive SCC, defined by nodal or distant metastasis or death by local progression of primary SCC. Standard questionnaires were completed by the researchers between July 18, 2005, and January 1, 2015. Data were analyzed between February 22, 2016, and July 12, 2016.

Results: Of the 51 participants, 43 were men and 8 were women, with a median age of 51 years (range, 19-71 years) at time of transplantation and 62 years (range, 36-77 years) at time of diagnosis of aggressive SCC. The distribution of aggressive SCC was preferentially on the face (34 [67%]) and scalp (6 [12%]), followed by the upper extremities (6 [12%]). A total of 21 tumors (41%) were poorly differentiated, with a median tumor diameter of 18.0 mm (range, 4.0-64.0 mm) and median tumor depth of 6.2 mm (range, 1.0-20.0 mm). Perineural invasion was present in 20 patients (39%), while 23 (45%) showed a local recurrence. The 5-year overall survival rate was 23%, while 5-year disease-specific survival was 30.5%.

Conclusions and relevance: Results of this case series suggest that anatomical site, differentiation, tumor diameter, tumor depth, and perineural invasion are important risk factors in aggressive SCC in solid organ transplant recipients.

Figure.. Squamous Cell Carcinoma (SCC) Overall Survival, Disease-Specific Survival, Progression-Free Survival, and Time From Metastasis to Death

A, An overall survival of 50% was reached at 28.0 months (95% CI, 21.3-34.7 months). Mean (SD) 5-year overall survival was 23.0% (6.4%), while mean (SD) 10-year overall survival was 11.3% (5.5%). B, A disease-specific survival of 50% disease-specific survival was reached at 33.0 months (95% CI, 0.9-45.1 months). Mean (SD) 5-year disease-specific survival was 30.5% (7.6%) and mean (SD) 10-year disease-specific survival was 25.9% (7.1%). C, Mean (SD) 5- and 10-year progression-free survival were 5% (1.3%) (95% CI, 2.5-7.3 years). D, Median time from metastasis to death was 12 months (95% CI, 3.8-20.2 months). Tick marks indicate censoring.