More metastases, deaths seen in cutaneous squamous cell carcinomas with lymphovascular invasion

The presence of lymphovascular invasion (LVI) in patients with cutaneous squamous cell carcinoma is associated with higher rates of metastasis and death at 5 years, reveals a recent study, noting that future staging systems must incorporate LVI.

A team of investigators evaluated the impact of LVI on cutaneous squamous cell carcinoma tumour outcomes in 10,707 tumours from a 20-year, retrospective, multicentre cohort, stratified by the presence (LVI⁺) or absence (LVI^–) of LVI.

The investigators then compared outcomes (ie, local recurrence, in-transit metastasis, nodal metastasis, disease-specific death) based on low (Brigham and Women's Hospital [BWH] stage T1/T2a) and high (BWH T2b/T3) tumour stages.

Of the tumours examined, 78 had LVI. Analysis of low-stage BWH tumours revealed that the LVI⁺ group, compared with LVI^–, had a significantly higher 5-year cumulative incidence of local recurrence (12.3 percent vs 1.1 percent; p<0.01), metastasis (4.2 percent vs 0.4 percnet; p<0.01), and disease-specific death (16.2 percent vs 0.4 percent; p<0.01).

These results were relatively consistent in the analysis of BWH high-stage tumours, which showed the LVI⁺ group maintaining a higher 5-year cumulative incidence of metastasis (28.5 percent vs 16.8 percent; p=0.06) and disease-specific death (25.3 percent vs 13.9 percent; p=0.03), but not local recurrence (16.3 percent vs 15.8 percent; p=0.11), compared with the LVI^– group.

Of note, this study was limited by its retrospective design.

“LVI is an aggressive histologic finding but is excluded from current staging systems due to its lack of demonstrated independent prognostic significance,” the investigators said.