Immunosuppression Risk Factor for Poor Outcomes in Squamous Cell Head and Neck Cancer

Researchers suggest that immunosuppression is an independent risk factor for worse outcomes in patients with cutaneous squamous cell carcinoma (cSCC) of the head and neck, based on findings from a retrospective study (JAMA Otolaryngol Head Neck Surg. 2019 Dec 5. Epub ahead of print).

“Patients with immunosuppression have a higher incidence of…cSCC…and often present with more aggressive, multifocal disease,” explained Samantha Tam, MD, MPH, Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, and colleagues.

Dr Tam et al conducted a retrospective study to determine the mortality risks of patients with cSCC and who do or do not have immunosuppression, as well as to compare the difference in mortality risk based on immunocompromise cause.

A total of 796 treatment-naïve patients with cSCC of the head and neck (median age, 69) were recruited for the study between January 1, 1995, and September 30, 2015.

Patients were divided into 2 cohorts based on immunosuppression status, and the primary end point of the study was disease-specific survival. The investigators evaluated the link between immune status and disease outcome using Cox proportional hazards regression model, and analyzed data from March 21, 2018, to April 4, 2019.

Ultimately, 147 and 649 patients in the study did and did not have immunosuppression. In the immunosuppression arm, 77 (52.4%) had diabetes, 39 (26.5%) had lymphoma or leukemia, 25 (17.0%) had an organ or stem cell transplant, and 3 (2.0%) had HIV.

The disease-specific survival rate at 5 years was 68.2% in the immunosuppression arm versus 84.1% in the nonimmunosuppression arm (difference, 15.9%; 95% CI, 3.5%-27.4%).

An independent association was determined between immunosuppression and worse disease-specific survival (hazard ratio, 2.32; 95% CI, 1.53-3.50).

“This study's findings suggest that immunosuppression is independently associated with a worse outcome in cSCC, with a 2.32 times increased risk of disease-specific death after adjusting for age, history of skin cancer, recurrent or persistent disease status, disease stage, and treatment,” Dr Tam and co-investigators concluded.—Hina Porcelli