March 3, 2026Open Access

Prognostic Factors of Locally Advanced Cutaneous Squamous Cell Carcinoma in Head and Neck Region in Transplanted Patients

Key Points

Low survival and worse prognosis observed in transplant patients with locally advanced cutaneous squamous cell carcinoma.
Transplanted patients exhibited a 3.69-fold increased risk of recurrence associated with neck metastasis extranodal extension.
Assessment involved a 16-year retrospective analysis of surgical treatments and clinical data from 156 patients.
Highlights the need for specific guidelines to standardize treatment and improve outcomes in this high-risk population.

Abstract

Background: Cutaneous squamous cell carcinoma (CSCC) is the second most common neoplasm in humans and the most frequent in Brazil (80% in the head and neck region, 20% mortality). Brazil is a world leader in organ transplants (more than 30,000 transplants in 2019). The risk of transplant patients (Tx) developing CSCC is 65-250 times higher, with deeper infiltration, advanced stage, higher local recurrence, occult metastases, and worse survival. Objective: To investigate the prognostic factors of locally advanced cutaneous squamous cell carcinoma (LACSCC) of the head and neck region in transplant patients. Methods: 16-year retrospective, single-center series of patients with LACSCC in the head and neck region who underwent surgical treatment. Clinical and Tx data, clinical/pathological stage, surgical treatment, parotid/regional and distant metastases, recurrence, and survival were analyzed. Results: 156 patients were included: 69.2% women, 65.3 years; mean primary size: 4.24 cm, 66% T3/T4 tumors, 71% grade 2/3 differentiation, 20.5% transplant recipients, follow-up: 33.6 months. The most affected regions were malar/nasal (28.8%) and auricular (19.2%). Surgeries included wide resection with reconstruction (58.9%), exenteration (14.1%), and temporalectomy (11.5%). Univariate analysis: Recurrence: immunosuppressor drugs (p = 0.009), transplanted (p = 0.006), compromised margin (p = 0.049); Mortality: immunosuppression (p = 0.028), total resection and reconstruction (p = 0.013), stage (8ed) III-IV (p p p = 0.018). Multivariate analysis: Recurrence: transplanted HR: 3.69 (p p p p = 0.032), compromised margins HR: 1.87 (p = 0.001). Main surgical procedures: temporalectomy HR: 2.83 (p = 0.007), major rhinectomy HR: 2.47 (p = 0.005); Worst overall survival: Tx compared to NonTx (p = 0.069); Worst survival with recurrence: Tx compared to NonTx (p = 0.005). Conclusions: The LACSCC and transplanted (immunosuppressed) group present low survival, worse prognosis; The formulation of specific guidelines to standardize treatment and predict outcomes on this population are strictly necessary.

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Cite This Study

Melo et al. (Tue,) studied this question.

synapsesocial.com/papers/69a75acac6e9836116a2111f https://doi.org/https://doi.org/10.3390/diagnostics16030404

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