Ardalan Ebrahimi1, Ziv Gil2, Moran Amit2, Tzu-Chen Yen3, Chun-Ta Liao3, Pankaj Chaturvedi4, Jai Prakash Agarwal4, Luiz P Kowalski5, Matthias Kreppel6, Claudio R Cernea7, Jose Brandao7, Gideon Bachar8, Andrea Bolzoni Villaret9, Dan Fliss10, Eran Fridman10, K Thomas Robbins11, Jatin P Shah12, Snehal G Patel12, Jonathan R Clark13. 1. Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia2Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia3Australian School of Advanced Medicine, Macquarie Universit. 2. The Laboratory for Applied Cancer Research, Haifa, Israel6Department of Otolaryngology Rambam Medical Center, Rappaport School of Medicine, the Technion, Israel institute of technology, Haifa, Israel. 3. Chang Gung Memorial Hospital, Taoyuan, Taiwan. 4. Tata Memorial Hospital, Mumbai, India. 5. Hospital A. C. Camargo, São Paulo, Brazil. 6. Department of Oral and Cranio-Maxillo and Facial Plastic Surgery University of Cologne, Cologne, Germany. 7. Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil. 8. Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel. 9. Ear, Nose, and Throat Department, University of Brescia, Brescia, Italy. 10. Department of Otolaryngology Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel. 11. Southern Illinois University School of Medicine, Springfield, Illinois. 12. Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York. 13. Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia2Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.
Abstract
IMPORTANCE: The current American Joint Committee on Cancer (AJCC) staging system for oral cancer demonstrates wide prognostic variability within each primary tumor stage and provides suboptimal staging and prognostic information for some patients. OBJECTIVE: To determine if a modified staging system for oral cancer that integrates depth of invasion (DOI) into the T categories improves prognostic performance compared with the current AJCC T staging. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of 3149 patients with oral squamous cell carcinoma treated with curative intent at 11 comprehensive cancer centers worldwide between 1990 and 2011 with surgery ± adjuvant therapy, with a median follow-up of 40 months. MAIN OUTCOMES AND MEASURES: We assessed the impact of DOI on disease-specific and overall survival in multivariable Cox proportional hazard models and investigated for institutional heterogeneity using 2-stage random effects meta-analyses. Candidate staging systems were developed after identification of optimal DOI cutpoints within each AJCC T category using the Akaike information criterion (AIC) and likelihood ratio tests. Staging systems were evaluated using the Harrel concordance index (C-index), AIC, and visual inspection for stratification into distinct prognostic categories, with internal validation using bootstrapping techniques. RESULTS: The mean and median DOI were 12.9 mm and 10.0 mm, respectively. On multivariable analysis, DOI was a significantly associated with disease-specific survival (P < .001), demonstrated no institutional prognostic heterogeneity (I² = 6.3%; P = .38), and resulted in improved model fit compared with T category alone (lower AIC, P < .001). Optimal cutpoints of 5 mm in T1 and 10 mm in T2-4 category disease were used to develop a modified T staging system that was preferred to the AJCC system on the basis of lower AIC, visual inspection of Kaplan-Meier curves, and significant improvement in bootstrapped C-index. CONCLUSIONS AND RELEVANCE: We propose an improved oral cancer T staging system based on incorporation of DOI that should be considered in future versions of the AJCC staging system after external validation.
IMPORTANCE: The current American Joint Committee on Cancer (AJCC) staging system for oral cancer demonstrates wide prognostic variability within each primary tumor stage and provides suboptimal staging and prognostic information for some patients. OBJECTIVE: To determine if a modified staging system for oral cancer that integrates depth of invasion (DOI) into the T categories improves prognostic performance compared with the current AJCC T staging. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of 3149 patients with oral squamous cell carcinoma treated with curative intent at 11 comprehensive cancer centers worldwide between 1990 and 2011 with surgery ± adjuvant therapy, with a median follow-up of 40 months. MAIN OUTCOMES AND MEASURES: We assessed the impact of DOI on disease-specific and overall survival in multivariable Cox proportional hazard models and investigated for institutional heterogeneity using 2-stage random effects meta-analyses. Candidate staging systems were developed after identification of optimal DOI cutpoints within each AJCC T category using the Akaike information criterion (AIC) and likelihood ratio tests. Staging systems were evaluated using the Harrel concordance index (C-index), AIC, and visual inspection for stratification into distinct prognostic categories, with internal validation using bootstrapping techniques. RESULTS: The mean and median DOI were 12.9 mm and 10.0 mm, respectively. On multivariable analysis, DOI was a significantly associated with disease-specific survival (P < .001), demonstrated no institutional prognostic heterogeneity (I² = 6.3%; P = .38), and resulted in improved model fit compared with T category alone (lower AIC, P < .001). Optimal cutpoints of 5 mm in T1 and 10 mm in T2-4 category disease were used to develop a modified T staging system that was preferred to the AJCC system on the basis of lower AIC, visual inspection of Kaplan-Meier curves, and significant improvement in bootstrapped C-index. CONCLUSIONS AND RELEVANCE: We propose an improved oral cancer T staging system based on incorporation of DOI that should be considered in future versions of the AJCC staging system after external validation.
Authors: Alhadi Almangush; Ibrahim O Bello; Ricardo D Coletta; Antti A Mäkitie; Laura K Mäkinen; Joonas H Kauppila; Matti Pukkila; Jaana Hagström; Jussi Laranne; Ylermi Soini; Veli-Matti Kosma; Petri Koivunen; Natalie Kelner; Luiz Paulo Kowalski; Reidar Grénman; Ilmo Leivo; Esa Läärä; Tuula Salo Journal: Virchows Arch Date: 2015-04-03 Impact factor: 4.064
Authors: Ardalan Ebrahimi; Ziv Gil; Moran Amit; Tzu-Chen Yen; Chun-Ta Liao; Pankaj Chaturvedi; Jai Prakash Agarwal; Luiz P Kowalski; Hugo F Köhler; Matthias Kreppel; Claudio R Cernea; Jason Brandao; Gideon Bachar; Andrea Bolzoni Villaret; Dan M Fliss; Eran Fridman; Kevin Thomas Robbins; Jatin P Shah; Snehal G Patel; Jonathan R Clark Journal: Head Neck Date: 2019-02-24 Impact factor: 3.147
Authors: Shaum Sridharan; Lester D R Thompson; Bibianna Purgina; Charles D Sturgis; Akeesha A Shah; Brian Burkey; Madalina Tuluc; David Cognetti; Bin Xu; Kevin Higgins; Juan C Hernandez-Prera; Dominick Guerrero; Manish M Bundele; Seungwon Kim; Umamaheswar Duvvuri; Robert L Ferris; William E Gooding; Simion I Chiosea Journal: Cancer Date: 2019-06-07 Impact factor: 6.860
Authors: G Tirelli; S Zacchigna; F Boscolo Nata; E Quatela; R Di Lenarda; M Piovesana Journal: Eur Arch Otorhinolaryngol Date: 2016-08-04 Impact factor: 2.503