M Amit1,2, T C Yen3, C T Liao3, P Chaturvedi4, J P Agarwal4, L P Kowalski5, Hugo F Kohler5, A Ebrahimi6,7, J R Clark6, C R Cernea8, S J Brandao8, M Kreppel9, J Zöller9, M D Fliss10, G Bachar11, T Shpitzer11, V A Bolzoni12, P R Patel13, S Jonnalagadda14, K T Robbins14, N G Iyer15, T Skanthakumar15, J P Shah16, S G Patel16, Z Gil17,18. 1. The Laboratory for Applied Cancer Research, Clinical Research Institute at Rambam, Rappaport Institute for Research in Medical Science, Haifa, Israel. 2. Department of Otolaryngology, Head and Neck Surgery, Head and Neck Center, Rambam Medical Center, Rappaport School of Medicine, The Technion, Israel Institute of Technology, 66036, Haifa, Israel. 3. Chang Gung Memorial Hospital, Taoyuan, Taiwan. 4. Tata Memorial Hospital, Mumbai, India. 5. A.C. Camargo Cancer Center, São Paulo, Brazil. 6. Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, Australia. 7. Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia. 8. Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil. 9. Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany. 10. Department of Pathology, Tel Aviv Medical Center, Tel Aviv, Israel. 11. Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel. 12. Department of ENT, University of Brescia, Owensboro, Italy. 13. University of Auckland, Auckland, New Zealand. 14. Southern Illinois University School of Medicine, Springfield, IL, USA. 15. Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre Singapore, Singapore, Singapore. 16. Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 17. The Laboratory for Applied Cancer Research, Clinical Research Institute at Rambam, Rappaport Institute for Research in Medical Science, Haifa, Israel. moranamit@gmail.com. 18. Department of Otolaryngology, Head and Neck Surgery, Head and Neck Center, Rambam Medical Center, Rappaport School of Medicine, The Technion, Israel Institute of Technology, 66036, Haifa, Israel. moranamit@gmail.com.
Abstract
BACKGROUND: The American Joint Committee on Cancer (AJCC) stage III classification of oral cavity squamous cell carcinoma (OCSCC) represents a heterogeneous group of patients with early local disease with regional metastases (T1N1 and T2N1) and advanced local disease with or without regional metastasis (T3N0 and T3N1). OBJECTIVE: The aim of this study was to evaluate prognostic heterogeneity in the stage III category. METHODS AND PATIENTS: An international retrospective multicenter study of 1815 patients who were treated for OCSCC from 2003 to 2011. RESULTS: Kaplan-Meier survival analysis and multivariate models of stage III patients revealed better overall survival (OS; HR 2.12, 95 % CI 1.03-4.15; p = 0.01) and disease-specific survival (DSS; HR 1.7, 95 % CI 1.16-4.12; p = 0.04) rates for patients with T1-2N1/T3N0 disease than for patients with T3N1 disease. The outcomes of patients with T3N1 and stage IVa disease were similar (p = 0.89 and p = 0.78 for OS and DSS, respectively). Modifying stage classification by transferring the T3N1 category to the stage VIa group resulted in a better prognostic performance [Harrell's concordance index, C index 0.76; Akaike's Information Criterion (AIC) 4131.6] compared with the AJCC 7th edition staging system (C index 0.65; AIC 4144.9) for OS. When DSS was assessed, the suggested staging system remained the best performing model (C index 0.71; AIC 1061.3) compared with the current AJCC 7th edition staging (C index 0.64; AIC 1066.2). CONCLUSIONS: The prognosis of T3N1 and stage IVa disease are similar in OCSCC, suggesting that these categories could be combined in future revisions of the nodal staging system to enhance prognostic accuracy.
BACKGROUND: The American Joint Committee on Cancer (AJCC) stage III classification of oral cavity squamous cell carcinoma (OCSCC) represents a heterogeneous group of patients with early local disease with regional metastases (T1N1 and T2N1) and advanced local disease with or without regional metastasis (T3N0 and T3N1). OBJECTIVE: The aim of this study was to evaluate prognostic heterogeneity in the stage III category. METHODS AND PATIENTS: An international retrospective multicenter study of 1815 patients who were treated for OCSCC from 2003 to 2011. RESULTS: Kaplan-Meier survival analysis and multivariate models of stage III patients revealed better overall survival (OS; HR 2.12, 95 % CI 1.03-4.15; p = 0.01) and disease-specific survival (DSS; HR 1.7, 95 % CI 1.16-4.12; p = 0.04) rates for patients with T1-2N1/T3N0 disease than for patients with T3N1 disease. The outcomes of patients with T3N1 and stage IVa disease were similar (p = 0.89 and p = 0.78 for OS and DSS, respectively). Modifying stage classification by transferring the T3N1 category to the stage VIa group resulted in a better prognostic performance [Harrell's concordance index, C index 0.76; Akaike's Information Criterion (AIC) 4131.6] compared with the AJCC 7th edition staging system (C index 0.65; AIC 4144.9) for OS. When DSS was assessed, the suggested staging system remained the best performing model (C index 0.71; AIC 1061.3) compared with the current AJCC 7th edition staging (C index 0.64; AIC 1066.2). CONCLUSIONS: The prognosis of T3N1 and stage IVa disease are similar in OCSCC, suggesting that these categories could be combined in future revisions of the nodal staging system to enhance prognostic accuracy.
Authors: K Thomas Robbins; Ashok R Shaha; Jesus E Medina; Joseph A Califano; Gregory T Wolf; Alfio Ferlito; Peter M Som; Terry A Day Journal: Arch Otolaryngol Head Neck Surg Date: 2008-05
Authors: Jacques Bernier; Jay S Cooper; T F Pajak; M van Glabbeke; J Bourhis; Arlene Forastiere; Esat Mahmut Ozsahin; John R Jacobs; J Jassem; Kie-Kian Ang; J L Lefèbvre Journal: Head Neck Date: 2005-10 Impact factor: 3.147
Authors: Kapila Manikantan; Suhail I Sayed; Konstantinos N Syrigos; Peter Rhys-Evans; Chris M Nutting; Kevin J Harrington; Rehan Kazi Journal: Cancer Treat Rev Date: 2009-08-22 Impact factor: 12.111