Patterns of major cutaneous surgeries and reconstructions in patients with cutaneous squamous cell carcinoma in the USA

Abstract

Aim: Since use of major cutaneous surgeries/reconstructions among patients with cutaneous squamous cell carcinoma (CSCC) is not well described, we sought to quantify major cutaneous surgeries/reconstructions among patients with CSCC who were newly diagnosed and for those treated with systemic therapy, stratified by immune status. Methods: We used the Optum^® Clinformatics^® Data Mart database (2013–2020) and Kaplan–Meier estimators to assess risk of surgeries/reconstructions. Results: 450,803 patients were identified with an incident CSCC diagnosis, including 4111 patients with CSCC who initiated systemic therapy. The respective 7-year risks of major cutaneous surgeries/reconstructions were 10.9% (95% CI: 10.7–11.0) and 21.8% (95% CI: 17.6–25.8). Overall risk of major cutaneous surgeries/reconstructions was higher in patients who were immunocompromised than those who were immunocompetent. Conclusion: Approximately one in nine patients with CSCC will undergo ≥1 major cutaneous surgeries/reconstructions within 7 years of diagnosis; the risk increases in patients who initiate systemic therapy and among those who are immunocompromised.

Plain language summary

Cutaneous squamous cell carcinoma (CSCC) is one of the two most common cancers, and numbers of new cases are increasing each year by 3–7%. A small number of advanced cases require systemic treatments (drugs given by mouth or injection), such as chemotherapy or immunotherapy. Patients with CSCC may require major skin surgeries and reconstructions. Little is known about how these skin procedures are used to treat patients with CSCC, particularly those with a weakened immune system. This analysis used USA insurance data of patients from 2013 to 2020 to assess how they were treated with surgeries, based on patients’ immune status and whether they had started systemic treatment for CSCC. Among the 450,803 patients identified with a new CSCC diagnosis, the chances of having a procedure over a 7-year period was 10.9% (around one in nine). For 4111 patients with CSCC who started systemic therapy, this was 21.8% (around one in five). The chances of having a procedure were also significantly higher in patients with a weakened immune system (14.0%, around one in seven), compared with those without. However, this study was potentially limited by the following: the study population might not fully represent the CSCC population, the risk of surgery might be underestimated and information about patients’ tumors (e.g., staging) was lacking. These results suggest there is an unmet need for systemic treatments that can reduce the burden of skin surgeries and reconstructions in CSCC.

Tweetable abstract

Around 1 in 9 patients with CSCC undergo ≥1 major cutaneous surgeries and reconstruction within 7 years of diagnosis; risk increases in patients who initiate systemic therapy and the immunocompromised. Therapies that minimise this risk are needed.

Keywords: :

• CSCC immunocompromised
• CSCC surgeries
• major cutaneous surgeries and reconstructions

Author contributions

All authors contributed to the study design, collection of data, analysis and writing of this manuscript. All authors approved the final version.

Financial disclosure

This study was funded by Regeneron Pharmaceuticals, responsibility for all opinions, conclusions and data interpretation lies with the authors. Inc. CI Chen, JJ Jalbert and N Wu are employees and shareholders of Regeneron Pharmaceuticals, Inc. ES Ruiz reports advisory board and consulting fees from Genentech, Leo Pharmaceuticals, Regeneron Pharmaceuticals, Inc. and Sanofi; and serves on the board of directors for Checkpoint Therapeutics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

Medical writing and editorial support under the direction of the authors was provided by Emmanuel Ogunnowo, PhD and John Facciponte, PhD, of Prime (Knutsford, UK) and funded by Regeneron Pharmaceuticals, Inc., according to Good Publication Practice guidelines (Link).

Ethical conduct of research

This research involves the secondary analysis of de-identified patient data and, as such, is exempt from both institutional review board approval and from human subject research informed consent.

Data sharing statement

The data underlying this article will be made available and shared for research purposes on reasonable request to the corresponding author.

Open access

This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/