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TOPLINE:

A multicenter retrospective study found that lymphovascular invasion (LVI) was an independent predictor of major poor outcomes in patients with cutaneous squamous cell carcinoma (CSCC).

METHODOLOGY:

• To determine whether LVI is an independent predictor of major poor outcomes in patients with CSCC, researchers conducted a multinational, retrospective database analysis of 23,166 CSCC cases from 14,825 patients across 12 centers (10 in the United States, 1 in Spain, and 1 in Brazil).
• They collected data on clinical and pathologic risk factors, including histologic differentiation, perineural invasion (PNI), LVI, tumor size, depth of invasion, treatment approaches, and patient outcomes.
• The main outcome was major poor outcomes, defined as nodal, in-transit, distant metastasis, or disease-specific death.
• Only 0.8% (179) of tumors were LVI-positive. LVI-positive tumors were more likely to show poor differentiation, PNI, and advanced stage.

TAKEAWAY:

• Patients with LVI had a greater incidence of local recurrence (13.4% vs 3.1%; P < .001), nodal metastasis (22.3% vs 1.9%; P < .001), in-transit metastasis (5.6% vs 0.4%; P < .01), distant metastasis (8.9% vs 0.6%; P < .001), and disease-specific death (17.9% vs 1.2%; P < .001) than those without LVI.
• LVI-positive tumors demonstrated significantly higher 3-year cumulative incidence of major poor outcomes than LVI-negative tumors (33.5% vs 3.2%; P < .001). The presence of LVI was associated with an 82% increased risk for major poor outcomes (subdistribution hazard ratio, 1.82; P = .002).
• Among patients with low-stage Brigham and Women’s Hospital tumors, those who were LVI-positive had a higher 3-year cumulative incidence of major poor outcomes than those who were LVI-negative (20.7% vs 1.6%; P < .001).
• LVI was associated with worse outcomes only in the absence of PNI, indicating a significant interaction between LVI and PNI (P = .01).

IN PRACTICE:

LVI-positive tumors “are associated with the development of major poor outcomes in a manner comparable to well-established high-risk factors such as PNI and depth of invasion,” authors of the study concluded. These results, they added, “emphasize the critical role of LVI as an independent risk predictor for poor outcomes in CSCC and highlight the need for its consideration in future refinements of CSCC staging systems to enhance their accuracy and clinical relevance.”

SOURCE:

The study was led by Kelsey E. Hirotsu, MD, Department of Dermatology, Stanford School of Medicine in Stanford, California, and was published online on April 17 in the Journal of the American Academy of Dermatology.

LIMITATIONS:

The retrospective design may limit generalizability. The rarity of LVI resulted in a small number of cases, and variability in clinical practice across centers could influence findings.

DISCLOSURES:

The study was supported in part by the American College of Mohs Surgery Foundation. Several authors reported receiving consulting fees, honoraria, funding support, grants, and advisory fees from various companies and being investigators or holding patents.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.