Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England

Zoë C. Venables (Lead / Corresponding author), Philippe Autier, Tamar Nijsten, Kwok F. Wong, Sinéad M. Langan, Brian Rous, John Broggio, Catherine Harwood, Katherine Henson, Charlotte M. Proby, Jem Rashbass, Irene M. Leigh

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Abstract

Importance: Cutaneous squamous cell carcinoma (cSCC) is the most common skin cancer with metastatic potential, but epidemiologic data are poor. Changes to the National Cancer Registration and Analysis Service (NCRAS) in England have allowed more accurate data analysis of primary and metastatic cSCC since 2013.

Objective: To assess the national incidence of cSCC and metastatic cSCC (mcSCC) in England from 2013 through 2015.

Design, Setting, and Participants: This national population-based study identified a cohort of patients with cSCC and mcSCC in England from January 1, 2013, through December 31, 2015. Patients were identified using diagnostic codes derived from pathology reports in the NCRAS. Data were analyzed from March 1, 2017, through March 1, 2018.

Main Outcomes and Measures: Incidence rates across sex and risk factors for cSCC were derived from the NCRAS data. Risk of occurrence of mcSCC among the population with cSCC was assessed with Cox proportional hazards regression analysis to determine indicators of mcSCC.

Results: Among the 76 977 patients with first primary cSCC in 2013 through 2015 (62.7% male; median age, 80 years [interquartile range, 72-86 years]), the age-standardized rates for the first registered cSCC in England from 2013 through 2015 were 77.3 per 100 000 person-years (PY) (95% CI, 76.6-78.0) in male patients and 34.1 per 100 000 PY (95% CI, 33.7-34.5) in female patients. Increased primary cSCC tumor count was observed in older, white male patients in lower deprivation quintiles. After a maximum follow-up of 36 months, cumulative incidence of mcSCC developed in 1.1% of women and 2.4% of men with a primary cSCC. Significant increases in the risk of metastasis with adjusted hazard rates of approximately 2.00 were observed in patients who were aged 80 to 89 years (hazard ratio [HR], 1.23; 95% CI, 1.07-1.43), 90 years or older (HR, 1.35; 95% CI, 1.09-1.66), male (HR, 1.79; 95% CI, 1.52-2.10), immunosuppressed (HR, 1.99; 95% CI, 1.64-2.42), and in higher deprivation quintiles (HR for highest quintile, 1.64; 95% CI, 1.35-2.00). Primary cSCC located on the ear (HR, 1.70; 95% CI, 1.42-2.03) and lip (HR, 1.85; 95% CI, 1.29-2.63) were at highest risk of metastasis.

Conclusions and Relevance: This study presents the first national study of the incidence of mcSCC. With limited health care resources and an aging population, accurate epidemiologic data are essential for informing future health care planning, identifying high-risk patients, and evaluating skin cancer prevention policies.

Original languageEnglish
Number of pages9
JournalJAMA Dermatology
Early online date28 Nov 2018
DOIs
Publication statusE-pub ahead of print - 28 Nov 2018

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England
Squamous Cell Carcinoma
Skin
Incidence
Skin Neoplasms
Neoplasms
Population
Neoplasm Metastasis
Delivery of Health Care
Sex Factors
Health Planning
Health Resources
Lip
Ear
Cohort Studies
Regression Analysis
Outcome Assessment (Health Care)
Pathology

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Venables, Zoë C. ; Autier, Philippe ; Nijsten, Tamar ; Wong, Kwok F. ; Langan, Sinéad M. ; Rous, Brian ; Broggio, John ; Harwood, Catherine ; Henson, Katherine ; Proby, Charlotte M. ; Rashbass, Jem ; Leigh, Irene M. / Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England. In: JAMA Dermatology. 2018.
@article{c6e9352e719a4295a1af201cc9acf19a,
title = "Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England",
abstract = "Importance: Cutaneous squamous cell carcinoma (cSCC) is the most common skin cancer with metastatic potential, but epidemiologic data are poor. Changes to the National Cancer Registration and Analysis Service (NCRAS) in England have allowed more accurate data analysis of primary and metastatic cSCC since 2013.Objective: To assess the national incidence of cSCC and metastatic cSCC (mcSCC) in England from 2013 through 2015.Design, Setting, and Participants: This national population-based study identified a cohort of patients with cSCC and mcSCC in England from January 1, 2013, through December 31, 2015. Patients were identified using diagnostic codes derived from pathology reports in the NCRAS. Data were analyzed from March 1, 2017, through March 1, 2018.Main Outcomes and Measures: Incidence rates across sex and risk factors for cSCC were derived from the NCRAS data. Risk of occurrence of mcSCC among the population with cSCC was assessed with Cox proportional hazards regression analysis to determine indicators of mcSCC.Results: Among the 76 977 patients with first primary cSCC in 2013 through 2015 (62.7{\%} male; median age, 80 years [interquartile range, 72-86 years]), the age-standardized rates for the first registered cSCC in England from 2013 through 2015 were 77.3 per 100 000 person-years (PY) (95{\%} CI, 76.6-78.0) in male patients and 34.1 per 100 000 PY (95{\%} CI, 33.7-34.5) in female patients. Increased primary cSCC tumor count was observed in older, white male patients in lower deprivation quintiles. After a maximum follow-up of 36 months, cumulative incidence of mcSCC developed in 1.1{\%} of women and 2.4{\%} of men with a primary cSCC. Significant increases in the risk of metastasis with adjusted hazard rates of approximately 2.00 were observed in patients who were aged 80 to 89 years (hazard ratio [HR], 1.23; 95{\%} CI, 1.07-1.43), 90 years or older (HR, 1.35; 95{\%} CI, 1.09-1.66), male (HR, 1.79; 95{\%} CI, 1.52-2.10), immunosuppressed (HR, 1.99; 95{\%} CI, 1.64-2.42), and in higher deprivation quintiles (HR for highest quintile, 1.64; 95{\%} CI, 1.35-2.00). Primary cSCC located on the ear (HR, 1.70; 95{\%} CI, 1.42-2.03) and lip (HR, 1.85; 95{\%} CI, 1.29-2.63) were at highest risk of metastasis.Conclusions and Relevance: This study presents the first national study of the incidence of mcSCC. With limited health care resources and an aging population, accurate epidemiologic data are essential for informing future health care planning, identifying high-risk patients, and evaluating skin cancer prevention policies.",
author = "Venables, {Zo{\"e} C.} and Philippe Autier and Tamar Nijsten and Wong, {Kwok F.} and Langan, {Sin{\'e}ad M.} and Brian Rous and John Broggio and Catherine Harwood and Katherine Henson and Proby, {Charlotte M.} and Jem Rashbass and Leigh, {Irene M.}",
note = "Funding/Support: This study was supported by a senior clinical fellowship in science award (No. 205039/Z/16/Z) from the Wellcome Trust (Dr Langan) and by an informatics fellowship from the British Association of Dermatologists and Genetic Medicine (Dr Venables).",
year = "2018",
month = "11",
day = "28",
doi = "10.1001/jamadermatol.2018.4219",
language = "English",
journal = "JAMA Dermatology",
issn = "2168-6068",
publisher = "American Medical Association",

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Venables, ZC, Autier, P, Nijsten, T, Wong, KF, Langan, SM, Rous, B, Broggio, J, Harwood, C, Henson, K, Proby, CM, Rashbass, J & Leigh, IM 2018, 'Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England', JAMA Dermatology. https://doi.org/10.1001/jamadermatol.2018.4219

Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England. / Venables, Zoë C. (Lead / Corresponding author); Autier, Philippe; Nijsten, Tamar; Wong, Kwok F.; Langan, Sinéad M.; Rous, Brian; Broggio, John; Harwood, Catherine; Henson, Katherine; Proby, Charlotte M.; Rashbass, Jem; Leigh, Irene M.

In: JAMA Dermatology, 28.11.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England

AU - Venables, Zoë C.

AU - Autier, Philippe

AU - Nijsten, Tamar

AU - Wong, Kwok F.

AU - Langan, Sinéad M.

AU - Rous, Brian

AU - Broggio, John

AU - Harwood, Catherine

AU - Henson, Katherine

AU - Proby, Charlotte M.

AU - Rashbass, Jem

AU - Leigh, Irene M.

N1 - Funding/Support: This study was supported by a senior clinical fellowship in science award (No. 205039/Z/16/Z) from the Wellcome Trust (Dr Langan) and by an informatics fellowship from the British Association of Dermatologists and Genetic Medicine (Dr Venables).

PY - 2018/11/28

Y1 - 2018/11/28

N2 - Importance: Cutaneous squamous cell carcinoma (cSCC) is the most common skin cancer with metastatic potential, but epidemiologic data are poor. Changes to the National Cancer Registration and Analysis Service (NCRAS) in England have allowed more accurate data analysis of primary and metastatic cSCC since 2013.Objective: To assess the national incidence of cSCC and metastatic cSCC (mcSCC) in England from 2013 through 2015.Design, Setting, and Participants: This national population-based study identified a cohort of patients with cSCC and mcSCC in England from January 1, 2013, through December 31, 2015. Patients were identified using diagnostic codes derived from pathology reports in the NCRAS. Data were analyzed from March 1, 2017, through March 1, 2018.Main Outcomes and Measures: Incidence rates across sex and risk factors for cSCC were derived from the NCRAS data. Risk of occurrence of mcSCC among the population with cSCC was assessed with Cox proportional hazards regression analysis to determine indicators of mcSCC.Results: Among the 76 977 patients with first primary cSCC in 2013 through 2015 (62.7% male; median age, 80 years [interquartile range, 72-86 years]), the age-standardized rates for the first registered cSCC in England from 2013 through 2015 were 77.3 per 100 000 person-years (PY) (95% CI, 76.6-78.0) in male patients and 34.1 per 100 000 PY (95% CI, 33.7-34.5) in female patients. Increased primary cSCC tumor count was observed in older, white male patients in lower deprivation quintiles. After a maximum follow-up of 36 months, cumulative incidence of mcSCC developed in 1.1% of women and 2.4% of men with a primary cSCC. Significant increases in the risk of metastasis with adjusted hazard rates of approximately 2.00 were observed in patients who were aged 80 to 89 years (hazard ratio [HR], 1.23; 95% CI, 1.07-1.43), 90 years or older (HR, 1.35; 95% CI, 1.09-1.66), male (HR, 1.79; 95% CI, 1.52-2.10), immunosuppressed (HR, 1.99; 95% CI, 1.64-2.42), and in higher deprivation quintiles (HR for highest quintile, 1.64; 95% CI, 1.35-2.00). Primary cSCC located on the ear (HR, 1.70; 95% CI, 1.42-2.03) and lip (HR, 1.85; 95% CI, 1.29-2.63) were at highest risk of metastasis.Conclusions and Relevance: This study presents the first national study of the incidence of mcSCC. With limited health care resources and an aging population, accurate epidemiologic data are essential for informing future health care planning, identifying high-risk patients, and evaluating skin cancer prevention policies.

AB - Importance: Cutaneous squamous cell carcinoma (cSCC) is the most common skin cancer with metastatic potential, but epidemiologic data are poor. Changes to the National Cancer Registration and Analysis Service (NCRAS) in England have allowed more accurate data analysis of primary and metastatic cSCC since 2013.Objective: To assess the national incidence of cSCC and metastatic cSCC (mcSCC) in England from 2013 through 2015.Design, Setting, and Participants: This national population-based study identified a cohort of patients with cSCC and mcSCC in England from January 1, 2013, through December 31, 2015. Patients were identified using diagnostic codes derived from pathology reports in the NCRAS. Data were analyzed from March 1, 2017, through March 1, 2018.Main Outcomes and Measures: Incidence rates across sex and risk factors for cSCC were derived from the NCRAS data. Risk of occurrence of mcSCC among the population with cSCC was assessed with Cox proportional hazards regression analysis to determine indicators of mcSCC.Results: Among the 76 977 patients with first primary cSCC in 2013 through 2015 (62.7% male; median age, 80 years [interquartile range, 72-86 years]), the age-standardized rates for the first registered cSCC in England from 2013 through 2015 were 77.3 per 100 000 person-years (PY) (95% CI, 76.6-78.0) in male patients and 34.1 per 100 000 PY (95% CI, 33.7-34.5) in female patients. Increased primary cSCC tumor count was observed in older, white male patients in lower deprivation quintiles. After a maximum follow-up of 36 months, cumulative incidence of mcSCC developed in 1.1% of women and 2.4% of men with a primary cSCC. Significant increases in the risk of metastasis with adjusted hazard rates of approximately 2.00 were observed in patients who were aged 80 to 89 years (hazard ratio [HR], 1.23; 95% CI, 1.07-1.43), 90 years or older (HR, 1.35; 95% CI, 1.09-1.66), male (HR, 1.79; 95% CI, 1.52-2.10), immunosuppressed (HR, 1.99; 95% CI, 1.64-2.42), and in higher deprivation quintiles (HR for highest quintile, 1.64; 95% CI, 1.35-2.00). Primary cSCC located on the ear (HR, 1.70; 95% CI, 1.42-2.03) and lip (HR, 1.85; 95% CI, 1.29-2.63) were at highest risk of metastasis.Conclusions and Relevance: This study presents the first national study of the incidence of mcSCC. With limited health care resources and an aging population, accurate epidemiologic data are essential for informing future health care planning, identifying high-risk patients, and evaluating skin cancer prevention policies.

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