O09 Cutaneous squamous cell carcinoma survival in England 2004–2020: a national retrospective observational cohort study
Authors: van Bodegraven Birgitta , Vernon Sally , Bright Chloe , Higgins Thomas , Jeffrey Polly , Ascott Anna , Gran Sonia , Harwood Catherine , Millington George , Proby Charlotte , Venables Zoe C 
Published: June 2024

Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common type of skin cancer, with 45 585 cSCCs recorded in England in 2020. cSCC net survival is published in the National Disease Registration Service (NDRS) Get Data Out programme and is reported as 90% at 5 years, similar to melanoma, breast cancer and prostate cancer, despite lower mortality rates for cSCC. The aim of this national retrospective cancer registry cohort study of NDRS data was to clarify published survival estimates by reporting the overall and cause-specific survival of people diagnosed with cSCC. Diagnoses of a first-ever cSCC tumour during 2004–20 were included. The end of follow-up was 5 January 2022. Immunosuppression was defined as a history of haematological malignancy, HIV, end-stage renal disease, or solid organ transplant, as identified in the Hospital Episode Statistics and NDRS cancer registrations. Cause-specific deaths were defined as the presence of the International Classification of Diseases 10th Revision code ‘C44’ (nonmelanoma skin cancer) on the death certificate. This work includes patient data collated by NDRS. Kaplan–Meier survival was estimated. Net survival was estimated using the Pohar Perme estimator. Cox proportional hazard regression was used to model associations with patient characteristics, including immunosuppression history and subsequent tumour development. In total, 415 236 first-ever cSCC tumours were identified, of which 415 166 were included in the survival analyses. The median age at diagnosis was 78 years (interquartile range 71–85) and 61.7% of patients (n = 256 163) were male. Overall, 26 200 (6.3%) were identified as immunosuppressed. In total, 230 533 deaths were observed, of which 13 270 (5.8%) were cause-specific deaths. Other commonly recorded causes of death included pneumonia (n = 60 440), chronic ischaemic heart disease (n = 55 779) and senility (n = 50 612). The 5-year Kaplan–Meier survival was 63.7%, 95% confidence interval (CI) 63.6–63.9. A significant survival difference was observed between men and women (χ2-test P &lt; 0.001), with median survival of 7.3 years (95% CI 7.3–7.4) and 8.1 years (95% CI 8.1–8.2), respectively. Associations between overall death and history of immunosuppression (hazard ratio 1.62, 95% CI 1.60–1.65) and overall death and second cSCC tumour (hazard ratio 1.43, 95% CI 1.41–1.44) were observed in univariate models and remained significant in adjusted models. The 3-year net survival rates were 93.7% (95% CI 93.2–94.1) and 94.1% (95% CI 93.7–94.5) for tumours diagnosed in 2013–15 and 2016–18, respectively. cSCC Kaplan–Meier median survival by sex (male 7.3 years, female 8.1 years) is lower than the expected population median survival at 78 years, which is 9.5 years for men and 11.0 years for women. This national study provides detailed information on cSCC survival in England over a 15-year period and provides information to patients and clinicians on expected survival after diagnosis.