Background: Lymphovascular invasion (LVI) is regarded as a high-risk feature of cutaneous squamous cell carcinoma (CSCC) but is currently absent from CSCC staging systems.
Objective: To assess whether LVI serves as an independent predictor of major poor outcomes in CSCC.
Methods: Twelve centers contributed to a multinational CSCC database. Clinical and pathologic risk factors, treatment, and patient outcomes were retrospectively collected. CSCCs were stratified based on LVI status. Tumors that developed major poor outcomes defined as nodal metastasis, in-transit metastasis, distant metastasis, and disease-specific death were identified.
Results: A total of 23,166 CSCCs were identified, 179 were LVI+ tumors (0.8%). LVI+ tumors had a higher cumulative incidence of major poor outcomes than those without LVI (33.5% vs 3.2% at 3 years; overall cumulative incidence function P < .001). In an adjusted analysis, LVI+ tumors had an 82% increase in the rate of developing major poor outcomes when compared to LVI- tumors (subdistribution hazard ratio = 1.82; P = .002). Notably, LVI+ low-stage Brigham and Women's Hospital (BWH) tumors (T1 or T2a) had a greater cumulative incidence of major poor outcomes compared to LVI- BWH low-stage tumors (20.7% vs 1.61% at 3 years, overall cumulative incidence function P < .001).
Limitations: Retrospective study design.
Conclusion: The presence of LVI in CSCC is a high-risk feature that is an independent predictor of metastasis and disease-specific death in both low and high BWH stage tumors.
Keywords: cutaneous squamous cell carcinoma; lymphovascular invasion; metastasis; nonmelanoma skin cancer; oncology; outcomes; recurrence.
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