1
|
Lounas M, Ylitalo L, Salmi T, Jernman J, Palve J, Luukkaala T, Korhonen N. Recent Changes in the Incidence and Characteristics of Cutaneous Squamous Cell Carcinomas in Finland from 2006 to 2020: A Retrospective Cohort Study. Acta Derm Venereol 2024; 104:adv39891. [PMID: 38813742 DOI: 10.2340/actadv.v104.39891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/24/2024] [Indexed: 05/31/2024] Open
Abstract
Registers recording only 1 tumour per patient do not enable assessment of the real burden of cutaneous squamous cell carcinoma. To investigate recent changes in the incidence and characteristics of tumours, a retrospective 15-year patient cohort study was performed in Finland. Histopathological diagnoses of cutaneous squamous cell carcinomas diagnosed between 2016 and 2020 were obtained from the pathology database and clinical data from patient medical records and combined with previously collected data for the years 2006-2015. Altogether 1,472 patients with 2,056 tumours were identified. The crude incidence increased from 19/100,000 persons in 2006 to 42 in 2020 (p < 0.001), increasing most in people aged over 80 years. The percentage of tumours located on the trunk increased from 5.3% during the first 5-year period, 2006-2010, to 9.0% in 2016-2020. Also, the location of tumours was significantly different between men and women, as men had more tumours on the scalp and ears, and women on the lower limbs. A slight change in the tumours from poorly to well differentiated and a decrease in the invasion depth were noted between 2006 and 2020. As the burden of tumours continues to increase, more attention should be paid to their prevention.
Collapse
Affiliation(s)
- Marika Lounas
- Department of Dermatology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Leea Ylitalo
- Department of Dermatology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Teea Salmi
- Department of Dermatology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juha Jernman
- Department of Pathology, Tampere University and Fimlab Laboratories, Tampere, Finland
| | - Johanna Palve
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland
| | - Tiina Luukkaala
- Research, Development and Innovation Centre, Tampere University Hospital and Health Sciences, Faculty of Social Sciences, Tampere University, Finland
| | - Niina Korhonen
- Department of Dermatology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| |
Collapse
|
2
|
Grover P, Flukes S, Jacques A, Leedman S, Lindsay A, White R, Friedland P, Gurfinkel R, Lim AM. Clinicopathological characteristics and clinical morbidity in high-risk head and neck cutaneous squamous cell carcinoma patients in Western Australia. Intern Med J 2021; 52:944-951. [PMID: 34800329 PMCID: PMC9324086 DOI: 10.1111/imj.15630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/08/2021] [Accepted: 11/18/2021] [Indexed: 12/24/2022]
Abstract
AIM To examine the clinicopathological features, mortality and morbidity in high-risk cutaneous squamous cell carcinoma (cSCC) patients in Western Australia (WA). METHODS A retrospective cohort study was conducted through hospital record review on cSCC patients discussed at multidisciplinary meetings at the two largest WA hospitals between March 2015 and December 2016. RESULTS 129/ 141 patients were evaluable with median follow-up of 43.9 (range 3.0-53.2) months. Patients were predominantly older males (84%) with significant comorbidities [Charlson Comorbidity Index (CCI) ≥5 (76%)] and history of previous non-melanoma skin cancer (57%) with advanced disease (57% stage IV without distant metastasis, AJCC 7th edition). Pathological high-risk features were common including nodal extracapsular extension (47%) and cranial nerve involvement (16%). Clinical morbidity was significant with a median of 2 (range 0-13) excisions and 2 (range 0-21) cSCC-related hospitalisations for any cSCC event following the index case discussion. Recurrences of the primary index lesion occurred in 60% of patients and 20% had ≥2 recurrences. Median overall survival for patients with non-metastatic disease was 39.8 (range 25.9-53.7) months and 16.1 (range 0.2-32.0) months for metastatic disease. CCI ≥5, advanced nodal stage and ≥2 recurrences were significantly associated with mortality on multivariable analyses (p<0.05). Nodal extracapsular extension and any recurrences were identified as significant risk factors for disease-specific mortality on multivariable analyses (p<0.05). CONCLUSION High-risk cSCC patients have significant health needs represented by high baseline comorbidities, multiplicity of cSCC events and the number of health-care associated interventions. There is an unmet need for robust cancer data collection. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Piyush Grover
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Department of Medical Oncology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Stephanie Flukes
- Department of Otolaryngology, Head and Neck, Skull Base Surgery, Fiona Stanley Hospital, Perth, WA, Australia
| | - Angela Jacques
- Department of Research, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Samuel Leedman
- Department of Otolaryngology, Head and Neck, Skull Base Surgery, Fiona Stanley Hospital, Perth, WA, Australia
| | - Andrew Lindsay
- Department of Otolaryngology, Head and Neck, Skull Base Surgery, Fiona Stanley Hospital, Perth, WA, Australia
| | - Rohen White
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Peter Friedland
- Department of Otolaryngology, Head and Neck, Skull Base Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Faculty of Medical and Health Sciences, University of Western Australia, Perth, WA, Australia
| | - Reuven Gurfinkel
- Department of Plastic and Reconstructive Surgery Oral and Cranio-Maxillofacial, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Annette M Lim
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Department of Medical Oncology, Sir Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, VIC, Australia
| |
Collapse
|
3
|
Thai AA, Lim AM, Solomon BJ, Rischin D. Biology and Treatment Advances in Cutaneous Squamous Cell Carcinoma. Cancers (Basel) 2021; 13:5645. [PMID: 34830796 PMCID: PMC8615870 DOI: 10.3390/cancers13225645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 12/24/2022] Open
Abstract
Cutaneous squamous cell carcinoma (CSCC) is the second most common skin cancer diagnosed worldwide. CSCC is generally localized and managed with local therapies such as excision and/or radiotherapy. For patients with unresectable or metastatic disease, recent improvements in our understanding of the underlying biology have led to significant advancements in treatment approaches-including the use of immune checkpoint inhibition (ICI)-which have resulted in substantial gains in response and survival compared to traditional cytotoxic approaches. However, there is a lack of understanding of the biology underpinning CSCC in immunocompromised patients, in whom the risk of developing CSCC is hundreds of times higher compared to immunocompetent patients. Furthermore, current ICI approaches are associated with significant risk of graft rejection in organ transplant recipients who make up a significant proportion of immunocompromised patients. Ongoing scientific and clinical research efforts are needed in order to maintain momentum to increase our understanding and refine our therapeutic approaches for patients with CSCC.
Collapse
Affiliation(s)
- Alesha A. Thai
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan St., Parkville, Melbourne, VIC 3000, Australia; (A.M.L.); (B.J.S.); (D.R.)
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Annette M. Lim
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan St., Parkville, Melbourne, VIC 3000, Australia; (A.M.L.); (B.J.S.); (D.R.)
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Benjamin J. Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan St., Parkville, Melbourne, VIC 3000, Australia; (A.M.L.); (B.J.S.); (D.R.)
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan St., Parkville, Melbourne, VIC 3000, Australia; (A.M.L.); (B.J.S.); (D.R.)
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
| |
Collapse
|
4
|
Dessinioti C, Pitoulias M, Stratigos AJ. Epidemiology of advanced cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol 2021; 36:39-50. [PMID: 34592000 DOI: 10.1111/jdv.17709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/02/2021] [Indexed: 12/27/2022]
Abstract
Cutaneous invasive squamous cell carcinoma (cSCC) most commonly presents as a typically indolent tumour with five-year cure rates of >90%. Advanced cSCC has been defined as locally advanced or metastatic (locoregional or distant) cSCC. The epidemiological data on advanced cSCC are rare due to underreporting or exclusion of cSCC from national cancer registries. Although the frequency of local recurrence has been reported, there is no clear evidence on the incidence or mortality of locally advanced cSCCs, e.g. locally infiltrating or locally recurrent cSCCs that are not further amenable to curative surgery or radiotherapy. This gap of knowledge on the epidemiology of locally advanced cSCC, highlights the need for standardisation in defining and reporting both locally advanced and metastatic cSCC. Even though metastatic cSCCs are a small part of cSCCs (3%-5%), their aggressive characteristics contribute to significant morbidity, higher mortality and are those likely to require systemic treatments. Locally recurrent and metastatic cSCC may occur more frequently in high-risk cSCCs (up to 35%). The site of metastasis involves in the vast majority the regional lymph nodes, with the head and neck lymph nodes or parotid most commonly affected. Metastasis occurs mostly within 2-3 years of the primary cSCC diagnosis. The knowledge of the incidence and prognosis of advanced cSCC and the risk stratification of patients, who may progress to advanced cSCC, emerge as pressing research areas with important implications for cost-efficiency planning and optimisation of patient care.
Collapse
Affiliation(s)
- C Dessinioti
- Department of Dermato-Oncology, 1st Department of Dermatology, Andreas Sygros Hospital, University of Athens, Athens, Greece
| | - M Pitoulias
- Department of Dermato-Oncology, 1st Department of Dermatology, Andreas Sygros Hospital, University of Athens, Athens, Greece
| | - A J Stratigos
- Department of Dermato-Oncology, 1st Department of Dermatology, Andreas Sygros Hospital, University of Athens, Athens, Greece
| |
Collapse
|
5
|
Ghetti G, D'Avella MC, Pradelli L. Preliminary Cost-Effectiveness and Cost-Utility Analysis of Cemiplimab in Patients with Advanced Cutaneous Squamous Cell Carcinoma in Italy. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:121-133. [PMID: 33603419 PMCID: PMC7882423 DOI: 10.2147/ceor.s295605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Cutaneous squamous cell carcinoma (CSCC) is a common cancer that in most cases is curable with surgery. About 3-5% of patients develop advanced CSCC (aCSCC) and are no longer responsive to surgery or radiation therapy. The aim of this study was to assess the cost-effectiveness and cost-utility of cemiplimab, the first systemic therapy approved in Italy for patients with aCSCC, vs platinum-based chemotherapy from the Italian National Health Service (SSN) perspective. Methods A partitioned survival model, which included three mutually exclusive health states, was developed to estimate costs and outcomes for patients with aCSCC, over a 30-year time horizon (lifetime). No direct evidence of the comparative efficacy and safety of cemiplimab versus other therapies currently exists. Therefore, a simulated treatment comparison (STC) was conducted to estimate the comparative efficacy of cemiplimab versus chemotherapy. Individual patient data for cemiplimab were collected from the EMPOWER-CSCC 1 trial whereas chemotherapy data were derived from a retrospective study. In the STC a regression model was used to predict outcomes for cemiplimab in the population observed in the comparator study. Costs of drug acquisition/administration and management of adverse events were included. Costs and outcomes were discounted at 3% per year. Incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were calculated; sensitivity and scenario analyses were performed to assess the robustness of results. Results In the base-case, treatment with cemiplimab was associated with a gain of 4.89 LYs and 3.99 QALYs, compared with a platinum-based chemotherapy regimen, resulting in an estimated ICER of 27,821 €/LY gained and an ICUR of 34,110 €/QALY gained. Both ICER and ICUR were below the commonly used Italian SSN willingness to pay thresholds. Conclusion The use of cemiplimab, compared with a platinum-based chemotherapy regimen, can be considered a cost-effective option for the treatment of aCSCC patients in Italy.
Collapse
Affiliation(s)
- Gianni Ghetti
- Department of Health Economics and Outcome Research, AdRes, Turin, Italy
| | | | - Lorenzo Pradelli
- Department of Health Economics and Outcome Research, AdRes, Turin, Italy
| |
Collapse
|
6
|
Cost of illness del carcinoma cutaneo a cellule squamose (CSCC). GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2020; 7:148-153. [PMID: 36627959 PMCID: PMC9677610 DOI: 10.33393/grhta.2020.2171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/23/2020] [Indexed: 01/13/2023] Open
Abstract
Background: Cutaneous squamous cell carcinoma (CSCC) is the second most frequent form of nonmelanoma skin cancer (NMSC) and accounts for 20-25% of skin cancers (AIOM Guidelines 2019). Objectives: The aim of this study was to estimate the total annual direct costs incurred by the National Health Service for the management and treatment of CSCC and advanced CSCC patients in Italy. Methods: An incidence-based cost of illness (COI) model was developed to estimate direct costs associated with the treatment and management of CSCC patients in Italy. The identified treatment pathway was validated with a team of clinical experts and was distinguished between resectable CSCC and locally advanced CSCC or metastatic CSCC. Treatments costs were obtained through the analysis of the National Hospital Discharge Database (HDD) for the years 2015-2018; monitoring and terminal care costs were obtained from national tariffs of outpatient care service and from the literature respectively. Results: Associating the estimated costs for each phase of the treatment pathway with the proportion of patients present in each phase, the COI model estimated an annual economic burden of about € 25.9 million for the management and treatment of patients with CSCC in Italy, € 2.7 million of which were associated to patients with advanced CSCC. The average cost per patient with advanced CSCC was higher compared to that of patient with resectable CSCC (€ 4,490 vs € 2,236 respectively). Conclusions: Our analysis showed that advanced CSCC patients are associated with a higher average cost than patients with resectable CSCC.
Collapse
|