Integrating depth of invasion in T classification improves the prognostic performance of the American Joint Committee on Cancer primary tumor staging system for cutaneous squamous cell carcinoma of the head and neck

Correlation between radiological, macroscopic and microscopic depth of invasion in oral squamous cell carcinoma: A prospective study using contrast-enhanced computed tomography

BACKGROUND

Depth of invasion (DOI) significantly influences prognosis and treatment strategies in oral squamous cell carcinoma (OSCC). Accurate preoperative imaging, such as contrast-enhanced computed tomography (CECT), alongside postoperative histopathological evaluations, aids in determining DOI. This study evaluates the correlation between radiological DOI (rDOI), macroscopic DOI (PDOI), and microscopic DOI (pDOI) in OSCC.

METHODS

This study included 54 OSCC patients from April 2022 to November 2023. rDOI was assessed using preoperative CECT, while PDOI and pDOI were measured through histopathological examination of resected specimens. Spearman correlation analysis and Bland-Altman plots assessed agreement between DOI measurements, with statistical significance set at p < 0.05.

RESULTS

Strong correlations were found between rDOI and PDOI (r = 0.713), rDOI and pDOI (r = 0.688), and PDOI and pDOI (r = 0.897, p < 0.001 for all). CECT overestimated DOI in T1 and T2 lesions, particularly in ulcerative tumors. Bland-Altman analysis showed mean differences of 1.86 mm (rDOI-PDOI) and 3.3 mm (rDOI-pDOI). Higher correlations were observed in the presence of perineural invasion (PNI), lymphovascular invasion (LVI), and worst pattern of invasion 5 (WPOI 5), with r values up to 0.948 (rDOI-PDOI) and 0.980 (PDOI-pDOI).

CONCLUSION

While rDOI correlates strongly with pathological DOI, overestimations in smaller and ulcerative lesions necessitate cautious interpretation. Pathological risk factors, including PNI, LVI, and WPOI 5, were associated with greater DOI and enhanced agreement between radiological and pathological assessments. Overall, CECT is a reliable tool for preoperative evaluation of DOI.

Evaluation of prognostic prediction ability of the novel Japanese risk factor scoring system in a Japanese cohort of resectable cutaneous squamous cell carcinoma: A retrospective cross-sectional study

Japanese patients with very high-risk cutaneous squamous cell carcinomas (cSCCs), based on the National Comprehensive Cancer Network guidelines, have been reported to display a higher cumulative incidence of relapse and disease-specific death (DSD) than those with high-risk cSCC. Therefore, prognosis prediction is crucial for Japanese patients with very high-risk cSCCs. Herein, we aimed to evaluate the prognostic prediction ability of our novel Japanese Risk Factor Scoring Systems (JARF scoring) in a Japanese cohort of cSSC patients. Data of 424 Japanese patients with resectable very high-risk cSCCs were analysed. We compared the prognostic ability of the following three staging systems: Brigham and Women's Hospital (BWH) tumour staging, number of NCCN very high-risk factors, and JARF scoring, including recurrent tumour, high-risk histological features, deep tumour invasion and lymphatic or vascular involvement as risk factors. The prognostic ability of these staging systems was evaluated according to the cumulative incidence of local recurrence (LR), regional lymph node metastasis (RLNM), DSD, and overall survival (OS). When BWH staging was used, high T stage led to significantly poor outcomes only in the cumulative incidence of RLNM (p = 0.01). The presence of very high-risk NCCN factors led to significantly poor outcomes in terms of RLNM (p = 0.03) and OS (p = 0.02). Meanwhile, a high number of risk factors in the JARF scoring system clearly led to poor outcomes in terms of LR (p = 0.01), RLNM (p < 0.01), DSD (p = 0.03), and OS (p < 0.01). The JARF scoring system may accurately predict the risk of recurrence and death in very high-risk cSCC patients in Japan.

Value of pre-treatment 18F-FDG PET/CT radiomics in predicting the prognosis of stage III-IV colorectal cancer

Background and purpose

To investigate the value of radiomics features extracted from pre-treatment ¹⁸F-FDG PET/CT in predicting the outcomes of stage III-IV colorectal cancer (CRC), which may assist in clinical management strategies and precise treatment of stage III-IV CRC.

Materials and methods

124 patients with pathologically confirmed stage III-IV CRC who underwent pre-treatment ¹⁸F-FDG PET/CT scans were enrolled in this study. The least absolute shrinkage and selection operator Cox regression (LASSO-Cox) was used to select radiomics features, and the radiomics scores (Rad-scores) were calculated to build radiomics models. The performance of radiomics models was represented by the concordance index (C-index) and compared with clinical models and complex model. The bootstrap resampling method was used to create validation sets. Additionally, nomograms were developed based on complex models.

Results

The C-indices of the radiomics model for predicting PFS and OS were 0.712 (95%CI: 0.680-0.744) and 0.758 (0.728-0.789), respectively. In the clinical model, these values were 0.690 (0.664-0.0.717) and 0.738 (0.709-0.767), respectively. However, in the complex model were 0.734 (0.705-0.762) and 0.780 (0.754-0.807), respectively. The Kaplan-Meier curves demonstrated that the radiomics model could effectively separate patients with stage III-IV stage CRC into high- and low-risk groups (p < 0.001). Multivariate Cox regression analysis confirmed the independent prognostic value of Rad-scores.

Conclusion

Pre-treatment ¹⁸F-FDG PET/CT radiomics features can stratify the risk of patients with stage III-IV CRC and accurately predict their outcomes. These findings could be clinically valuable for precision treatment and management decisions in stage III-IV CRC.

Cutaneous squamous cell carcinoma of head and neck region: A single center analysis of 1296 tumors with clinical characteristics, comorbidities, treatment, and sun-protection behavior

Cutaneous squamous cell carcinoma (SCC) is the second most common non-melanoma skin cancer among Caucasians. We analyzed our data on tumors been treated between 2006 and 2016 at the Skin Cancer Center of an academic teaching hospital. Thousand hundred and ninety-four patients with 1296 SCC have been identified including 804 males (67.3%) and 390 females (32.7%). The mean age among females was significantly higher with (83.9 ± 7.9) years compared with males ([79.3 ± 8.1] years; P < .001). The most common tumor localizations were outer ears (n = 227, 17.5%), scalp (216, 16.7%), and forehead (215, 16.6%). The majority of tumors was stage I. 31.9% of patients had previous SCC or Bowen's cancer, 29.1% had actinic keratoses. Major non-dermatological comorbidities were cardiovascular diseases and diabetes. SCC were treated by delayed Mohs surgery. First Mohs procedure resulted in R0 status in 83.9%. Most cases with R1 resection were located on nose and eyelids. For a subpopulation of patients (n = 105), a structured questionnaire study evaluated changes in sun protection behavior after skin cancer. After the confirmed diagnosis of a cutaneous SCC concerns about harm to the skin by intense sunlight was reported by 78.4% (76) of participants, with 92.0% among females versus 73.6% among males. Eighty percent of females and 76.8% of males wanted to care more about sun-protection in the future, spend less time 84.0% (females) and 72.5% (males) in the sun, and adapt their leisure activities for a better sun protection in 92.0% (females) and 81.9% (males). Secondary prevention in males needs improvement.