Abstract
Cutaneous squamous cell carcinoma (cSCC) often presents localized to skin, but when it metastasizes to regional lymph nodes prognosis declines. Despite this, the role for detecting metastasis through sentinel lymph node biopsy (SLNB) is not well defined. This study uses the National Cancer Database (NCDB) to evaluate the role of SLNB in cSCC.
cSCC patients who underwent complete surgical excision (CSE) alone or CSE + SLNB were selected from the NCDB from 2012-2020. Overall survival (OS) in these cohorts were compared. Subgroup analyses of SLNB status and addition of completion lymph node dissection (CLND) was performed. Adjusted hazard ratio (aHR) and 95% confidence interval (95% CI) were calculated.
Of 2730 patients, 42.3% underwent SLNB, and 15.4% had positive SLNB. Univariate survival analysis showed better OS in CSE + SLNB vs. CSE alone (HR 0.85, 95% CI 0.74, 0.98, p=0.0253), and worse OS in SLNB positive vs. negative patients (HR 2.82, 95% CI 2.22, 3.58, p<.0001). In an adjusted survival model, better OS was associated with CSE + SLNB vs. CSE alone (HR 0.70, 95% CI 0.59, 0.82, p<.001), worse OS was associated with male sex, co-morbid conditions, ≥ T2 tumor, and lymphovascular invasion. Subgroup analysis of SLNB positive patients showed no OS benefit with CLND (HR 0.63, 95% CI 0.30, 1.33, p=0.221).
An OS benefit was seen in patients who underwent SLNB, but not CLND. While this may reflect a selection bias of the study population, given that a positive SLNB was associated with worse OS and new trials show survival benefit with use of adjuvant therapies, future studies are needed to define the role for SLNB in cSCC patients.