Prognostic Factors of Locally Advanced Cutaneous Squamous Cell Carcinoma in Head and Neck Region in Transplanted Patients

<b>Background:</b> Cutaneous squamous cell carcinoma (CSCC) is the second most common neoplasm in humans and the most frequent in Brazil (80% in the head and neck region, 20% mortality). Brazil is a world leader in organ transplants (more than 30,000 transplants in 2019). The risk of transplant patients (Tx) developing CSCC is 65-250 times higher, with deeper infiltration, advanced stage, higher local recurrence, occult metastases, and worse survival. <b>Objective:</b> To investigate the prognostic factors of locally advanced cutaneous squamous cell carcinoma (LACSCC) of the head and neck region in transplant patients. <b>Methods:</b> 16-year retrospective, single-center series of patients with LACSCC in the head and neck region who underwent surgical treatment. Clinical and Tx data, clinical/pathological stage, surgical treatment, parotid/regional and distant metastases, recurrence, and survival were analyzed. <b>Results:</b> 156 patients were included: 69.2% women, 65.3 years; mean primary size: 4.24 cm, 66% T3/T4 tumors, 71% grade 2/3 differentiation, 20.5% transplant recipients, follow-up: 33.6 months. The most affected regions were malar/nasal (28.8%) and auricular (19.2%). Surgeries included wide resection with reconstruction (58.9%), exenteration (14.1%), and temporalectomy (11.5%). Univariate analysis: Recurrence: immunosuppressor drugs (<i>p</i> = 0.009), transplanted (<i>p</i> = 0.006), compromised margin (<i>p</i> = 0.049); Mortality: immunosuppression (<i>p</i> = 0.028), total resection and reconstruction (<i>p</i> = 0.013), stage (8ed) III-IV (<i>p</i> < 0.001), compromised margin (<i>p</i> < 0.001), neck metastasis with extranodal extension (<i>p</i> = 0.018). Multivariate analysis: Recurrence: transplanted HR: 3.69 (<i>p</i> < 0.001), neck metastasis extranodal extension HR: 5.41 (<i>p</i> < 0.001), evolution to distant metastasis HR: 5.27 (<i>p</i> < 0.001); Mortality: neck metastasis extranodal extension HR: 1.94, (<i>p</i> = 0.032), compromised margins HR: 1.87 (<i>p</i> = 0.001). Main surgical procedures: temporalectomy HR: 2.83 (<i>p</i> = 0.007), major rhinectomy HR: 2.47 (<i>p</i> = 0.005); Worst overall survival: Tx compared to NonTx (<i>p</i> = 0.069); Worst survival with recurrence: Tx compared to NonTx (<i>p</i> = 0.005). <b>Conclusions:</b> The LACSCC and transplanted (immunosuppressed) group present low survival, worse prognosis; The formulation of specific guidelines to standardize treatment and predict outcomes on this population are strictly necessary.