Chun-Ta Liao1, Li-Yu Lee2, Chuen Hsueh2, Chien-Yu Lin3, Kang-Hsing Fan3, Hung-Ming Wang4, Chia-Hsun Hsieh4, Shu-Hang Ng5, Chih-Hung Lin6, Chung-Kan Tsao6, Chung-Jan Kang1, Tuan-Jen Fang1, Shiang-Fu Huang1, Kai-Ping Chang1, Lan Yan Yang7, Tzu-Chen Yen8. 1. Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC. 2. Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Pathology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC. 3. Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC. 4. Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Medical Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC. 5. Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC. 6. Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Plastic and Reconstructive Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC. 7. Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Biostatistics and Informatics Unit, Clinical Trial Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC. 8. Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC. Electronic address: yen1110@adm.cgmh.org.tw.
Abstract
OBJECTIVE: According to the AJCC 2017 Staging Manual, oral cavity squamous cell carcinoma (OCSCC) with pN2 disease (based on the AJCC 2010 criteria) and extra-nodal extension (ENE) should be classified as pN3b. We performed a detailed outcome analyses in this patient subgroup. MATERIAL AND METHODS: We retrospectively reviewed the clinical records of consecutive OCSCC patients who underwent radical surgery between 1996 and 2017. Patients with pN3b disease (n = 365) were divided into a pN+ ≥8/ENE ≥5 subgroup (defined by the presence of pN+ ≥8 nodes or ENE ≥5 nodes, n = 77) and a pN+ ≤7/ENE ≤4 subgroup (defined by the presence of pN+ ≤7 nodes and ENE ≤4 nodes, n = 288). Patients with pN0/pN1/pN2 (n = 1192/179/197) disease were included for comparison purposes. RESULTS: Patients in the pN+ ≥8/ENE ≥5 subgroup had less favorable 5-year outcomes than those in the pN+ ≤7/ENE ≤4/pN2/pN1/pN0 groups (local control, 64%/79%/86%/83%/88%, p < 0.001; neck control, 55%/75%/80%/86%/93%, p < 0.001; distant metastases, 67%/28%/20%/12%/3%, p < 0.001; disease-free survival, 21%/51%/64%/72%/82%, p < 0.001; disease-specific survival, 25%/55%/71%/82%/92%, p < 0.001; overall survival, 19%/40%/54%/64%/82%, p < 0.001; respectively). Among patients with pN3b disease, multivariable analysis identified the pN+ ≥8/ENE ≥5 subgroup, lower neck (level IV/V) metastases, and depth of invasion ≥25 mm as independent adverse prognostic factors for 5-year distant metastases and survival rates. CONCLUSIONS: Patients in the pN+ ≥8/ENE ≥5 subgroup have an unfavorable prognosis and their classification as pN3b is advisable. In contrast, patients in the pN+ ≤7/ENE ≤4 subgroup should be classified as pN3a.
OBJECTIVE: According to the AJCC 2017 Staging Manual, oral cavity squamous cell carcinoma (OCSCC) with pN2 disease (based on the AJCC 2010 criteria) and extra-nodal extension (ENE) should be classified as pN3b. We performed a detailed outcome analyses in this patient subgroup. MATERIAL AND METHODS: We retrospectively reviewed the clinical records of consecutive OCSCC patients who underwent radical surgery between 1996 and 2017. Patients with pN3b disease (n = 365) were divided into a pN+ ≥8/ENE ≥5 subgroup (defined by the presence of pN+ ≥8 nodes or ENE ≥5 nodes, n = 77) and a pN+ ≤7/ENE ≤4 subgroup (defined by the presence of pN+ ≤7 nodes and ENE ≤4 nodes, n = 288). Patients with pN0/pN1/pN2 (n = 1192/179/197) disease were included for comparison purposes. RESULTS:Patients in the pN+ ≥8/ENE ≥5 subgroup had less favorable 5-year outcomes than those in the pN+ ≤7/ENE ≤4/pN2/pN1/pN0 groups (local control, 64%/79%/86%/83%/88%, p < 0.001; neck control, 55%/75%/80%/86%/93%, p < 0.001; distant metastases, 67%/28%/20%/12%/3%, p < 0.001; disease-free survival, 21%/51%/64%/72%/82%, p < 0.001; disease-specific survival, 25%/55%/71%/82%/92%, p < 0.001; overall survival, 19%/40%/54%/64%/82%, p < 0.001; respectively). Among patients with pN3b disease, multivariable analysis identified the pN+ ≥8/ENE ≥5 subgroup, lower neck (level IV/V) metastases, and depth of invasion ≥25 mm as independent adverse prognostic factors for 5-year distant metastases and survival rates. CONCLUSIONS:Patients in the pN+ ≥8/ENE ≥5 subgroup have an unfavorable prognosis and their classification as pN3b is advisable. In contrast, patients in the pN+ ≤7/ENE ≤4 subgroup should be classified as pN3a.
Authors: Andreas Pabst; Daniel G E Thiem; Elisabeth Goetze; Alexander K Bartella; Michael T Neuhaus; Jürgen Hoffmann; Alexander-N Zeller Journal: Clin Oral Investig Date: 2021-03-29 Impact factor: 3.573