Nikolaus Moeckelmann1,2, Ardalan Ebrahimi3, Richard Dirven4, Jessica Liu5, Tsu-Hui Hubert Low4,6, Ruta Gupta5,6, Bruce Ashford7,8,9,10, Sydney Ch'ng4,6, Carsten E Palme4,6, Jonathan R Clark4,6,11. 1. Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia. n.moeckelmann@uke.de. 2. Department of Otolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. n.moeckelmann@uke.de. 3. Department of Head and Neck Surgery, Liverpool Hospital, Liverpool, NSW, Australia. 4. Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia. 5. Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia. 6. Central Clinical School, University of Sydney, Sydney, Australia. 7. School of Biological Sciences, University of Wollongong, Wollongong, Australia. 8. Illawarra Health and Medical Research Institute (IHMRI), Wollongong, Australia. 9. Illawarra and Shoalhaven Local Health District (ISLHD), Wollongong, Australia. 10. Centre for Oncology Education and Research Translation (CONCERT), Liverpool, Australia. 11. South West Clinical School, University of New South Wales, Sydney, Australia.
Abstract
BACKGROUND: The American Joint Committee on Cancer (AJCC) uses the same nodal staging system for cutaneous and mucosal squamous cell carcinoma of the head and neck in its 8th edition (AJCC 8) despite differences in the etiology, risk factors, and clinical behavior of the two diseases. This study aims to evaluate the performance of the AJCC 8 nodal staging system by direct comparison of cutaneous (cSCC) versus oral squamous cell carcinoma (oSCC) patients. METHODS: Patients with metastatic cSCC (N = 382) and oSCC (N = 325) were identified from a prospective database (years 1987-2016). Multivariable analysis was performed using Cox proportional hazards competing risk model. To assess staging system performance, an explained variation measure (proportion of variation explained, PVE) as well as a discrimination measure (Harrell's concordance index, C-index) were used. RESULTS: Inclusion of extranodal extension (ENE) in AJCC 8 increased the proportion of patients in N3b category (48.7% in cSCC, 40.3% in oSCC). AJCC 8 stratified poorly with regards to risk of death from cSCC and oSCC and showed limited monotonicity of the nodal categories. Estimates of model performance revealed modest predictive capacity for overall survival (OS) and disease-specific survival (DSS) in oSCC (Harrell's C of 0.66 in both) and weak predictive capacity in cSCC (Harrell's C of 0.58 and 0.61, respectively). CONCLUSIONS: The AJCC 8 nodal staging system performs poorly in terms of stratifying survival by N category, especially in cSCC. The data indicate that cSCC merits an independent nodal staging system from that for mucosal SCC.
BACKGROUND: The American Joint Committee on Cancer (AJCC) uses the same nodal staging system for cutaneous and mucosal squamous cell carcinoma of the head and neck in its 8th edition (AJCC 8) despite differences in the etiology, risk factors, and clinical behavior of the two diseases. This study aims to evaluate the performance of the AJCC 8 nodal staging system by direct comparison of cutaneous (cSCC) versus oral squamous cell carcinoma (oSCC) patients. METHODS:Patients with metastatic cSCC (N = 382) and oSCC (N = 325) were identified from a prospective database (years 1987-2016). Multivariable analysis was performed using Cox proportional hazards competing risk model. To assess staging system performance, an explained variation measure (proportion of variation explained, PVE) as well as a discrimination measure (Harrell's concordance index, C-index) were used. RESULTS: Inclusion of extranodal extension (ENE) in AJCC 8 increased the proportion of patients in N3b category (48.7% in cSCC, 40.3% in oSCC). AJCC 8 stratified poorly with regards to risk of death from cSCC and oSCC and showed limited monotonicity of the nodal categories. Estimates of model performance revealed modest predictive capacity for overall survival (OS) and disease-specific survival (DSS) in oSCC (Harrell's C of 0.66 in both) and weak predictive capacity in cSCC (Harrell's C of 0.58 and 0.61, respectively). CONCLUSIONS: The AJCC 8 nodal staging system performs poorly in terms of stratifying survival by N category, especially in cSCC. The data indicate that cSCC merits an independent nodal staging system from that for mucosal SCC.
Authors: Jacqueline Dinnes; Jonathan J Deeks; Naomi Chuchu; Rubeta N Matin; Kai Yuen Wong; Roger Benjamin Aldridge; Alana Durack; Abha Gulati; Sue Ann Chan; Louise Johnston; Susan E Bayliss; Jo Leonardi-Bee; Yemisi Takwoingi; Clare Davenport; Colette O'Sullivan; Hamid Tehrani; Hywel C Williams Journal: Cochrane Database Syst Rev Date: 2018-12-04
Authors: Lavinia Ferrante di Ruffano; Yemisi Takwoingi; Jacqueline Dinnes; Naomi Chuchu; Susan E Bayliss; Clare Davenport; Rubeta N Matin; Kathie Godfrey; Colette O'Sullivan; Abha Gulati; Sue Ann Chan; Alana Durack; Susan O'Connell; Matthew D Gardiner; Jeffrey Bamber; Jonathan J Deeks; Hywel C Williams Journal: Cochrane Database Syst Rev Date: 2018-12-04
Authors: Naomi Chuchu; Jacqueline Dinnes; Yemisi Takwoingi; Rubeta N Matin; Susan E Bayliss; Clare Davenport; Jacqueline F Moreau; Oliver Bassett; Kathie Godfrey; Colette O'Sullivan; Fiona M Walter; Richard Motley; Jonathan J Deeks; Hywel C Williams Journal: Cochrane Database Syst Rev Date: 2018-12-04
Authors: Elahe Minaei; Simon A Mueller; Bruce Ashford; Amarinder Singh Thind; Jenny Mitchell; Jay R Perry; Benjamin Genenger; Jonathan R Clark; Ruta Gupta; Marie Ranson Journal: Front Oncol Date: 2022-04-11 Impact factor: 5.738