Cutaneous squamous cell carcinoma is, after basal cell carcinoma, the second most common form of cancer in the Netherlands, with around 16,000 new patients each year. Due to an aging population, these numbers are steadily increasing. To provide patients with appropriate and efficient care, doctors need better tools to predict which patients require intensive treatment and follow-up—and which do not.
A Major Step Forward
This new, globally unique database represents a significant step toward personalized care. It was built using data from the nationwide pathology database PALGA and the Netherlands Cancer Registry, managed by the Netherlands Comprehensive Cancer Organisation (IKNL). Dermatologist Dr. Marlies Wakkee and epidemiologist Dr. Loes Hollestein published a paper on this initiative in Lancet Regional Health Europe.
Tailored Advice for Patients
The database is particularly important for patients with advanced CSCC. ‘Treatment decisions for these patients are often based on expert opinion rather than based on scientific evidence’, explains Wakkee. ‘That’s because, until now, there hasn’t been a centralized source of data on these cases.’
Immunotherapy and Predictive Models
Patients with advanced CSCC are often treated with additional radiotherapy and, increasingly, immunotherapy. ‘Our goal is to develop accurate predictive models to identify which patients will benefit most from these therapies’, says Wakkee. ‘This is crucial because these treatments can sometimes cause severe, long lasting side effects. The new database will help us create these models.’
To achieve this, researchers need deeper insight into tumor behavior—something that only becomes possible when patterns emerge from a large pool of patient data.
Smart Algorithm
Hollestein developed an algorithm capable of scanning pathology reports for indicators of advanced or metastatic tumors, such as ‘deeply invasive,’ ‘metastases,’ ‘amputation,’ and ‘recurrence.’ After initial validation, these cases were linked to the Netherlands Cancer Registry. This approach allowed advanced CSCC cases to be registered efficiently, without manually reviewing thousands of patient files.
The analysis revealed that about 8% of all CSCC in the Netherlandsare advanced—nearly 2,000 tumors annually. In addition, there are around 250 patients each year with metastatic CSCC and 500 with recurrent tumors. ‘For the first time, we know how many high-risk tumors occur in the Netherlands’, says Hollestein.
Next Steps: Personalized Treatment
The next phase is to make the database accessible for research in collaboration with dermatologists, surgeons, radiotherapists, and oncologists. The aim is to enable clinicians to make better treatment decisions based on the tumor characteristics of new patients. Wakkee and Hollestein hope this will become reality within five years.
The paper, Longitudinal data on advanced cutaneous squamous cell carcinoma from the Dutch Keratinocyte Cancer Collaborative (DKCC): a nationwide real-world database study, was produced in collaboration with colleagues from Erasmus MC, PALGA, IKNL, and the national multidisciplinary advisory board for this database.
