Prevalence of poor outcomes in cutaneous squamous cell carcinoma by AJCC and BWH tumor stages: A systematic review and meta-analysis.

Abstract

Cutaneous squamous cell carcinoma (cSCC) generally has a favorable prognosis, but some patients experience poor outcomes (POs). To evaluate the prevalence of POs in cSCC patients by American Joint Committee on Cancer (AJCC) and Brigham and Women's Hospital (BWH) tumor stages. A systematic review and meta-analysis were conducted using PubMed, Medline, and SCOPUS on November 15, 2023. Studies reporting POs by AJCC or BWH stages in cSCC patients were included. Meta-analysis was performed using a random effects model. Out of 3364 articles, 30 studies were included. For AJCC 8, local recurrence rates were 3.6% (T1), 5.4% (T2), 11.1% (T3), and 21.5% (T4). Nodal metastasis (NM) rates were 1.5% (T1), 9.8% (T2), 19.6% (T3), and 47.4% (T4). For BWH stages, local recurrence rates were 2.7% (T1), 7.5% (T2a), 15.7% (T2b), and 33.5% (T3). NM rates were 0.7% (T1), 3.9% (T2a), 16.7% (T2b), and 40.9% (T3). Heterogeneity in study designs and reporting standards may impact findings. Some stages had limited data, leading to wider confidence intervals. This meta-analysis highlights prognostic differences between AJCC 7, AJCC 8, and BWH staging systems, with BWH providing nuanced stratification for NM. Personalized risk assessment is essential in managing cSCC.