What causes the death of patients with cutaneous squamous cell carcinoma? A prospective analysis in 1400 patients.

Introduction: Cutaneous squamous cell carcinoma (cSCC) is a common tumor of elderly Caucasian patients.

Methods: Competing multivariable risk models to analyze different types of cSCC associated death (local infiltration [LI], locoregional [LR], and distant metastases [DM]) in terms of prognostic factors.

Results And Discussion: 1400 patients were analyzed. In the adjusted multivariable subdistribution hazard approach for tumor volume, the best model for death of cSCC overall revealed the presence of desmoplasia (HR 4.52; p < 0.001), bone invasion (HR 10.06; p < 0.01), and immunosuppression (HR 3.19; p = 0.003) as significant factors. Death due to LI indicated desmoplasia (HR 15.39; p < 0.01) and bone invasion (HR 16.9; p < 0.001) as significant factors. For death by LM, immunosuppression with a HR of 3.27; p = 0.004 was the only significant prognostic factors as well as in death by DM with a HR of 4.54; p = 0.02.

Conclusions: The three types of death caused by cSCC can be distinguished based on risk factors with different weights. Patients with these factors should be monitored closely.