Davide Lombardi1, Michele Tomasoni2, Alberto Paderno2, Davide Mattavelli2, Marco Ferrari3, Simonetta Battocchio4, Francesco Missale5, Francesco Mazzola6, Giorgio Peretti7, Davide Mocellin6, Daniele Borsetto8, Jonathan M Fussey8, Paul Nankivell8, Nikoleta Skalidi8, Mario Bussi9, Leone Giordano9, Andrea Galli9, Gianluigi Arrigoni10, Elena Raffetti11, Paul Pracy8, Vincent Vander Poorten12, Piero Nicolai13. 1. Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Italy. Electronic address: davinter@libero.it. 2. Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Italy. 3. Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Italy; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy. 4. Unit of Pathology, University of Brescia, Italy. 5. Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy. 6. Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy. 7. Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy. 8. Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom. 9. Department of Otorhinolaryngology, IRCCS San Raffaele Scientific Institute, Milan, Italy. 10. Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy. 11. Epidemiology and Public Health Intervention Research Group (EPHIR), Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden. 12. Otorhinolaryngology - Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium. 13. Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy.
Abstract
OBJECTIVES: Despite differences in oncological behavior, the 8th edition of AJCC TNM staging currently proposes the same N-classification for major salivary glands (MSG) carcinoma and squamous cell carcinoma of the upper aerodigestive tract. The present study aims to investigate a more reliable definition of N-categories for MSG carcinoma. MATERIALS AND METHODS: A retrospective multicenter study was performed, including 307 patients treated for primary MSG carcinoma from 1995 to 2019. Outcome measures included overall survival (OS), disease specific survival, and local, regional, and distant recurrence. Survival analysis was performed using log-rank test and Cox proportional-hazards model. Overall number (ON) and largest diameter (LD) of nodal metastases, including intra-parotid metastases, were considered to develop three novel proposals of N-classification; their performance were compared with the current TNM staging using Akaike information criterion (AIC), Bayesian information criterion (BIC), and Nagelkerke pseudo-R2. RESULTS: Intra-parotid nodes, ON and LD of nodal metastases emerged as major prognosticators for OS, while extra-nodal extension did not impact on any survival. The current N-classification did not show a satisfactory OS stratification. Three novel N-classifications were developed according to number of metastatic nodes (0 vs 1-3 vs ≥ 4) and/or their maximum diameter (<20 mm vs ≥ 20 mm). They all showed better accuracy in OS stratification, and achieved better AIC, BIC and Nagelkerke pseudo-R2 indices when compared to current N-classification. CONCLUSION: All the proposed N-classifications improved OS stratification and could help in defining a specific N-classification for MSG carcinoma. Their validation and assessment in an external cohort is needed.
OBJECTIVES: Despite differences in oncological behavior, the 8th edition of AJCC TNM staging currently proposes the same N-classification for major salivary glands (MSG) carcinoma and squamous cell carcinoma of the upper aerodigestive tract. The present study aims to investigate a more reliable definition of N-categories for MSG carcinoma. MATERIALS AND METHODS: A retrospective multicenter study was performed, including 307 patients treated for primary MSG carcinoma from 1995 to 2019. Outcome measures included overall survival (OS), disease specific survival, and local, regional, and distant recurrence. Survival analysis was performed using log-rank test and Cox proportional-hazards model. Overall number (ON) and largest diameter (LD) of nodalmetastases, including intra-parotid metastases, were considered to develop three novel proposals of N-classification; their performance were compared with the current TNM staging using Akaike information criterion (AIC), Bayesian information criterion (BIC), and Nagelkerke pseudo-R2. RESULTS: Intra-parotid nodes, ON and LD of nodalmetastases emerged as major prognosticators for OS, while extra-nodal extension did not impact on any survival. The current N-classification did not show a satisfactory OS stratification. Three novel N-classifications were developed according to number of metastatic nodes (0 vs 1-3 vs ≥ 4) and/or their maximum diameter (<20 mm vs ≥ 20 mm). They all showed better accuracy in OS stratification, and achieved better AIC, BIC and Nagelkerke pseudo-R2 indices when compared to current N-classification. CONCLUSION: All the proposed N-classifications improved OS stratification and could help in defining a specific N-classification for MSG carcinoma. Their validation and assessment in an external cohort is needed.
Authors: Mussab Kouka; Benjamin Koehler; Jens Buentzel; Holger Kaftan; Daniel Boeger; Andreas H Mueller; Andrea Wittig; Stefan Schultze-Mosgau; Thomas Ernst; Peter Schlattmann; Orlando Guntinas-Lichius Journal: Cancers (Basel) Date: 2022-06-07 Impact factor: 6.575