- Design
- Retrospective validation cohort
- Population
- 572 patients with high-risk cutaneous squamous cell carcinoma
- Primary outcome
- Metastasis and local recurrence risk by i40-GEP class
- Effect
- Class 1A NPV >95%; Class 2B (12.9%) 3-year MFS 66.2%
An integrated score combining a 40-gene expression profile with five clinicopathological features — immunosuppression, site, differentiation, diameter and perineural invasion — was validated retrospectively in 572 high-risk cutaneous squamous cell carcinomas.
The score separated metastatic and local recurrence risk (p < 0.001). The lowest class had over 95% negative predictive value. The highest class, 12.9% of patients, had 3-year metastasis-free survival of 66.2% and appeared to benefit from adjuvant radiotherapy.
If confirmed, a test like this could spare low-risk patients radiotherapy and target it to those most likely to benefit. But the radiotherapy benefit comes from a retrospective, non-randomised comparison, and the test is proprietary and not available in India.
- Keep staging with existing systems (BWH or AJCC) as the basis of decisions.
- Record the five clinicopathological features in every high-risk cSCC report.
- Discuss adjuvant radiotherapy in a multidisciplinary meeting, not on a test result alone.
- Treat the gene profile as an adjunct under evaluation.
Why it matters
It points to a way to target radiotherapy in cSCC, where current staging over- and under-treats.
Don't overread it
The radiotherapy benefit is from a retrospective subgroup, not a randomised comparison.
The statistics, in plain English
A negative predictive value above 95% means fewer than 1 in 20 patients called low risk went on to the outcome. That depends on how common the outcome was in this cohort and may be lower elsewhere. No hazard ratio for the radiotherapy effect was reported in the abstract.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for dermatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free