Analysis Of The Risk Factors Of Postoperative Recurrence And Establishment Of A Nomogram Predictive Model In Patients With Cutaneous Squamous Cell Carcinoma

Background and ObjectivesCutaneous squamous cell carcinoma(CSCC)is a common skin malignancy that originates from the epidermis or adnexal keratinocytes.Cutaneous squamous cell carcinoma has always been seen on sun-exposed skin sites,including face,head,and neck areas.It could lead to damages on local tissues along with disfigurement of exposed areas,and has a serious impact on the health and quality of life to patients.The incidence rate of CSCC has been increasing rapidly in recent years and the therapeutic effect of CSCC is good,but the high recurrence rate is still the key factor affecting the therapeutic effect.The purpose of the research is to explore the risk factors of postoperative recurrence in patients with cutaneous squamous cell carcinoma,and establish a nomogram model to predict the risk factors of recurrenc,in order to reduce the postoperative recurrence rate of patients.Methods1.Retrospective analysis of the clinical data of patients diagnosed with CSCC in the first affiliated hospital of Zhengzhou university from January 2015 to January 2020.155 cases of cutaneous squamous cell carcinoma were diagnosed by the department of pathology who were admitted to the plastic surgery department,and 126 cases were successfully followed up with a follow-up rate of 81.3%.The clinical characteristics of the patients were collected including gender,age,incubation period,lesion diameter and location,chronic inflammatory state,degree of invasion,pathological grade,postoperative radiotherapy,methods of repair,lymph node metastasis.In all cases,the surgical method of enlarged resection of the lesion was adopted,and rapid pathological examination was performed during the operation.The follow-up period was 12-60 months.2.SPSS25.0 software was uesd to analyze the collected data to screen out the independent risk factors by chi-square and multivariate logistic regression analysis.Based on the results,a nomogram predictive model was established by using R software(r4.0.0)and RMS software,and the prediction accuracy of the model was verified.Results1.Among the 126 patients,the youngest was 34 years old and the oldest was 89 years old.The male to female ratio was about 1.1:1.0.The cases in H area accounted for 42.9%,M area 37.3%and L area 19.8%.61.1%of the tumors invaded the superficial dermis and 38.9%of the tumors invaded the deep dermis and other tissues.84.9%of the tumors were well-differentiated and 15.1%were poorly differentiated.Cases with chronic inflammatory state accounted for 53.2%.The proportion of patients with tumor latency less than 1 year was 10.3%,1-2 years was 24.6%,and more than 2 years was 65.1%.Cases of lesion diameter greater than or eaqul to 5.10cm accounted for 31.0%,and less than 5.10cm accounted for 69.0%.Cases with lymph node metastasis accounted for 10.3%.Cases received radiotherapy after operation accounted for 52.4%.18.3%of cases were directly sutured,34.1%of cases were free skin grafts,and 47.6%of cases were local skin flap.There were 23 patients with recurrence,accounting for 18.3%.2.The clinical data of the patients were analyzed including gender,age,incubation period,lesion diameter and location,chronic inflammatory state,degree of invasion,pathological grade,postoperative radiotherapy,methods of repair,lymph node metastasis.Logistic reggression analysis showed that age(p=0.005),pathological grade(p=0.016),degree of invasion(p=0.028),lymph node metastasis(p=0.046)and postoperative radiotherapy(p<0.001)were independent risk factors for recurrence of cutaneous squamous cell carcinoma.3.A nomogram predictive model was established based on above five risk factors.The model verification showed that the C-index of the nomogram predictive model was 0.851(95%confidence interval:0.823-0.880).A high C-index of 0.824 was reached by Bootstrap self sampling method,indicating that the model had good consistency.The nomogram score of each patient participating in this study was calculated and the ROC curve was drawn,and AUC was 0.882,indicating that the model had a good predictive ability.Conclusions1.Diameter of lesion is a related factor of postoperative recurrence in patients with cutaneous squamous cell carcinoma.Age,degree of invasion,pathological grade,postoperative radiotherapy and lymph node metastasis are independent risk factors for postoperative recurrence in patients with cutaneous squamous cell carcinoma.2.The nomogram predictive model has high forecast accuracy and can be conveniently used to predict the recurrence risk of postoperative recurrence in patients with cutaneous squamous cell carcinoma.3.Early,timely,proper treatment is an important measure to reduce the recurrence rate and improve the prognosis in patients with cutaneous squamous cell carcinoma.