Outcomes of Transplant Patients Treated Surgically for Node Positive Cutaneous Squamous Cell Carcinoma

Abstract

Objectives:

Patients with chronic immune suppression are at increased risk of developing cutaneous squamous cell carcinoma of the head and neck (cSCCHN) and often present with advanced stage disease. The purpose of our study was to investigate the survival of transplant patients on chronic immunosuppressive therapies treated surgically for node-positive cSCCHN.

Methods:

Patients from a tertiary-care center with node-positive cSCCHN were identified from 1993-2012. Demographic, surgical, and pathological data were extracted from the electronic medical record for all patients treated surgically with curative intent. Outcomes were compared between transplant and non-transplant patients using Kaplan-Meier estimates.

Results:

Eighty-six (80M, 6F) patients with a median age of 73 years were identified. Seven (8%) patients had previous transplant surgery. The median time of immune suppression prior to diagnosis was 8 years (range 5-19). Four (57%) transplant patients presented with recurrent disease. Surgical pathology showed positive margins in 5 (71%) transplant patients compared to 18 (23%) non-transplant patients, P = 0.01. Perineural invasion, angiolymphatic invasion, and extracapsular spread were not significantly different on tumor pathology between groups. Four (57%) transplant patients had adjuvant radiotherapy. The median survival of transplant patients was 13.0 months (range 9-26) vs. 29.9 months (range 1.5-149) in non-transplant patients. Patients with recurrent disease demonstrated reduced survival, P = 0.03. Adjuvant radiotherapy improved survival regardless of transplant status, P = 0.001.

Conclusions:

Transplant patients treated surgically for node-positive cSCCHN have an increased risk of recurrent disease, adverse pathological features, and reduced survival compared to non-transplant patients.