Risk Prediction Model for Cutaneous SCC in Cardiac Allograft Recipients

N. Nair, D. Du, Z. Hu, E. Gongora

Research output: Contribution to journalArticlepeer-review


PURPOSE: Post-transplant patients are at increased risk for squamous cell carcinoma (SCC) of the skin, secondary to long-term immunosuppression. This study was undertaken to identify risk factors using the UNOS database population. METHODS: The study population of 1766 patients derived from the UNOS database (2000-2015) was divided into two equal groups. One group was used for testing and the other for validation. Descriptive statistics were used to characterize the study cohort. Cox's proportional hazards regression was used to investigate the effect of different risk factors for SCC post-heart transplantation. Multivariate analysis was used to test the correlation between SCC and potential risk factors. Hazard ratio (OR) and the 95% confidence interval (CI) were calculated for each risk factor. Statistical significance was set at p< 0.05. Forward sequential feature selection was done to select significant risk factors for multivariate modeling. The multivariate model was used to predict the risk of SCC at 5, 8 and 10 years post-transplant. Analyses were performed using MATLAB software from The Math Works, Inc. Receiver Operating Curves (ROCs) were generated to derive Area Under the Curve (AUC) to assess the quality of the prediction model. RESULTS: Multivariate analysis showed that Black, Hispanic and other races as compared to whites had an OR of 0.07,0.35, 0.17 (p=0.0000). Recipient PRAs had an OR of 0.97 (p=<0.0001). Age >60 years had an OR of 2.5 (p=0.0000). Males had an OR of 2.05 (p=0.000). The ROC curves generated showed AUC at 5, 8 and 10 years post-transplant of 0.76, 0.76, 0.76 respectively in the testing set and 0.79, 0.77, 0.78 respectively in the validation set (figure 1). CONCLUSION: Male sex, white race, age >60 years higher PRAs are major risk factors for SCC. The risk prediction model generated for the first time for SCC in post-cardiac transplant patients has a robust c-statistic of >0.75. This is important for risk stratification as SCC is the most common skin cancer seen in the post-cardiac transplant population.

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