Samenvatting
Keratinocyte carcinoma is the most common (skin) cancer worldwide and includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). In general, patients with BCC and SCC have a good prognosis, but SCC can metastasize, leading to a poor prognosis.
We found the following risk factors for metastasis from SCC: location on the ear, tumor diameter >50 mm, moderate and poor differentiation and tumor thickness >2 mm. Specifically, in the elderly aged 75 years or older, but not in younger patients, the risk factors for disease progression were tumor diameter ≥40 mm, moderate differentiation and invasion depth ≥2 mm. This shows that there is a difference in tumor characteristics between older and younger patients. However, in the current SCC treatment guideline, patient characteristics such as age are not taken into consideration. In addition to age, other patient characteristics may also be relevant for determining an appropriate treatment for skin cancer patients, such as frailty and life expectancy. It is especially important for elderly and frail patients to weigh the pros and cons of a treatment. On the one hand, they may not live long enough to benefit from comprehensive treatment. On the other hand, undertreatment can also lead to morbidity. In a prospective pilot study, we found that less intensive treatment, which occurred significantly more often in frail patients with a limited life expectancy, did not lead to more complications, worse quality of life or disease progression on the shortterm. Therefore, this may be considered in certain patient groups, but more research is needed in larger patient populations with longer follow-up.
We found the following risk factors for metastasis from SCC: location on the ear, tumor diameter >50 mm, moderate and poor differentiation and tumor thickness >2 mm. Specifically, in the elderly aged 75 years or older, but not in younger patients, the risk factors for disease progression were tumor diameter ≥40 mm, moderate differentiation and invasion depth ≥2 mm. This shows that there is a difference in tumor characteristics between older and younger patients. However, in the current SCC treatment guideline, patient characteristics such as age are not taken into consideration. In addition to age, other patient characteristics may also be relevant for determining an appropriate treatment for skin cancer patients, such as frailty and life expectancy. It is especially important for elderly and frail patients to weigh the pros and cons of a treatment. On the one hand, they may not live long enough to benefit from comprehensive treatment. On the other hand, undertreatment can also lead to morbidity. In a prospective pilot study, we found that less intensive treatment, which occurred significantly more often in frail patients with a limited life expectancy, did not lead to more complications, worse quality of life or disease progression on the shortterm. Therefore, this may be considered in certain patient groups, but more research is needed in larger patient populations with longer follow-up.
| Originele taal-2 | English |
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| Kwalificatie | Doctor of Philosophy |
| Toekennende instantie |
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| Begeleider(s)/adviseur |
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| Datum van toekenning | 5-okt.-2022 |
| Plaats van publicatie | [Groningen] |
| Uitgever | |
| DOI's | |
| Status | Published - 2022 |