Journal of the American Academy of Dermatology · 2020
Delineation of clinical and biological factors associated with cutaneous squamous cell carcinoma among patients with chronic lymphocytic leukemia.
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Kleinstern Geffen, Rishi Abdul, Achenbach Sara J, Rabe Kari G, Kay Neil E, Shanafelt Tait D, Ding Wei, Leis Joe F, Norman Aaron D, Call Timothy G, Cerhan James R, Parikh Sameer A, Baum Christian L, Slager Susan L
Аннотация
BACKGROUND: The incidence of cutaneous squamous cell carcinoma (SCC) in patients with chronic lymphocytic leukemia (CLL) is significantly higher compared with age- and sex-matched controls.
OBJECTIVE: To evaluate the association of factors associated with SCC risk.
METHODS: Clinical CLL and SCC data were obtained from Mayo Clinic CLL Resource and self-reported questionnaires among patients with newly diagnosed CLL. We computed the CLL International Prognostic Index (CLL-IPI) from CLL prognostic factors, and a polygenic risk score from SCC susceptibility variants. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
RESULTS: Among 1269 patients with CLL, the median follow-up was 7 years, and SCC subsequently developed in 124 patients. Significant associations with SCC risk were history of skin cancer (HR=4.80; 95% CI: 3.37-6.83), CLL-IPI (HR=1.42; 95% CI: 1.13-1.80), and polygenic risk score (HR=2.58; 95% CI: 1.50-4.43). In a multivariable model, these factors were independent predictors (C statistic = 0.69; 95% CI: 0.62-0.76). T-cell immunosuppressive treatments were also associated with SCC risk (HR=2.29; 95% CI: 1.47-3.55; adjusted for age, sex, and prior SCC).
LIMITATIONS: The sample size decreases when combining all risk factors in a single model.
CONCLUSION: SCC risk includes history of skin cancer, an aggressive disease at time of CLL diagnosis, receiving T-cell immunosuppressive treatments, and high polygenic risk score. Future studies should develop prediction models that include these factors to improved screening guidelines.
OBJECTIVE: To evaluate the association of factors associated with SCC risk.
METHODS: Clinical CLL and SCC data were obtained from Mayo Clinic CLL Resource and self-reported questionnaires among patients with newly diagnosed CLL. We computed the CLL International Prognostic Index (CLL-IPI) from CLL prognostic factors, and a polygenic risk score from SCC susceptibility variants. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
RESULTS: Among 1269 patients with CLL, the median follow-up was 7 years, and SCC subsequently developed in 124 patients. Significant associations with SCC risk were history of skin cancer (HR=4.80; 95% CI: 3.37-6.83), CLL-IPI (HR=1.42; 95% CI: 1.13-1.80), and polygenic risk score (HR=2.58; 95% CI: 1.50-4.43). In a multivariable model, these factors were independent predictors (C statistic = 0.69; 95% CI: 0.62-0.76). T-cell immunosuppressive treatments were also associated with SCC risk (HR=2.29; 95% CI: 1.47-3.55; adjusted for age, sex, and prior SCC).
LIMITATIONS: The sample size decreases when combining all risk factors in a single model.
CONCLUSION: SCC risk includes history of skin cancer, an aggressive disease at time of CLL diagnosis, receiving T-cell immunosuppressive treatments, and high polygenic risk score. Future studies should develop prediction models that include these factors to improved screening guidelines.
Предметные рубрики MeSH
AdultAgedAged, 80 and overBiomarkers, TumorCarcinoma, Squamous CellDermatologyFemaleFollow-Up StudiesGenetic Predisposition to DiseaseHumansImmunosuppressive AgentsIncidenceLeukemia, Lymphocytic, Chronic, B-CellMaleMass ScreeningMedical History TakingMedical OncologyMiddle AgedPractice Guidelines as TopicPrognosisRisk AssessmentRisk FactorsSkinSkin NeoplasmsT-LymphocytesYoung Adult