Published online Mar 18, 2021. doi: 10.5500/wjt.v11.i3.54
Peer-review started: September 6, 2020
First decision: December 1, 2020
Revised: December 25, 2020
Accepted: February 19, 2021
Article in press: February 19, 2021
Published online: March 18, 2021
Heart transplant recipients are at higher risk of developing skin cancer than the general population due to the long-term immunosuppression treatment. Cancer has been reported as one of the major causes of morbidity and mortality for patients after heart transplantation.
Cutaneous squamous cell carcinoma (cSCC) is reported as the most common skin cancer in adult heart transplant recipients. This study was initiated to develop a risk stratification model using the United Network for Organ Sharing database in order to identify important risk factors and predict post-transplant incidence of cSCC. Among the different types of skin cancers, cSCC is the most common type of cancer. Timely screening and better management would help in prevention of long-term complications.
To identify risk factors and predict the incidence of cSCC for heart transplant recipients. Develop a risk prediction model for cSCC.
The whole dataset was randomly divided into a derivation set (80%) and a validation set (20%). Uni- and multivariate Cox regression were done to identify significant risk factors associated with the development of cSCC. Receiver operating characteristics curves were generated and area under the curve (AUC) was calculated to assess the accuracy of the prediction model.
Of the 23736 heart-transplant recipients in the database during the study period, 1827 were reported to have cSCC. Significant predictors of post-transplant cSCC were older age, male sex, white race, recipient and donor human leukocyte antigen mismatch level, malignancy at listing, a diagnosis of restrictive myopathy or hypertrophic myopathy, re-transplantation of the heart, and induction therapy with OKT3 or daclizumab. The multivariate model was used to predict the 5-, 8- and 10-year incidence of cSCC and respectively provided AUC of 0.79, 0.78, and 0.77 in the derivation set and 0.80, 0.78, and 0.77 in the validation set. The risk scoring system assigned each patient with a risk score within the range of 0-11. Based on the scores they were stratified into 4 different risk groups. The predicted and observed 5-year probability of developing cSCC match well among different risk groups. In addition, the log-rank test indicated significantly different cSCC-free survival across different groups.
A risk prediction model for cSCC among heart-transplant recipients has been generated for the first time. It offers a c-statistic of ≥ 0.77 in both derivation and validation sets.
Using a risk prediction score for screening of adult cardiac allograft recipients for early detection of cSCC can become a reality. The risk prediction score can be further validated in independent data sets in the future. Identification of risk factors is an important step towards the prevention of cSCC in this population.