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Soo Park, MD
Soo Park, MD
Posted: Monday, August 26, 2024
Shayan Cheraghlou, MD, of New York University Grossman School of Medicine, and colleagues convened an international expert panel to determine guidelines for recording and analyzing retrospective data on cutaneous squamous cell carcinoma. Their consensus statement, which was published in JAMA Dermatology, may also provide an avenue for the standardization of future prospective studies.
A total of 13 dermatologists and dermatologic surgeons were recruited by the International Immunosuppression & Transplant Skin Cancer Collaborative (ITSCC). Each panelist was required to have more than 5 post-training years of experience and “considerable” experience in performing data outcomes research on cutaneous squamous cell carcinoma.
According to the panel, the following contributing factors should be considered for the assignment of index tumors in patients with poor outcomes and multiple primary tumors (in descending order of importance): tumor location relative to the site of metastasis; temporal relationship between the development of the primary tumor and poor outcome; prior treatment factors; and the presence of high-risk tumor features. They agreed that the default starting time (T0) for time-to-event analyses should represent the time of initial histopathologic confirmation of the primary tumor.
Consensus recommendations were achieved for defining specific disease outcomes, such as local recurrence, direct extension, parotid metastasis, satellite metastasis, in-transit metastasis, nodal metastasis, distant metastasis, and disease-specific death. The panel recommended using Fine-Gray competing risk and Cox proportional hazards models for the statistical analyses of cutaneous squamous cell carcinoma disease outcomes and overall survival, respectively.
“As helpful as these guidelines are…, one issue that was not addressed specifically is when to determine the date of metastasis for the time-to-event analyses,” commented Lee Wheless, MD, PhD, of Vanderbilt University Medical Center, Nashville, in an accompanying editorial in JAMA Dermatology. “Another issue is that these guidelines for defining recurrence, direct tumor extension, and metastasis rely heavily on expert opinion, drawing from the melanoma literature.”
Disclosure: Dr. Cheraghlou reported no conflicts of interest. For full disclosures of the other study authors, visit jamanetwork.com.
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