Eric M Anderson1,2, Michael Luu3, Bonnie L Balzer4, Kevin S Scher2,5,6, Alain C Mita2,5, Diana J Lu1,2, Stephen L Shiao1,2, Jon Mallen-St Clair2,7, Allen S Ho2,7, Zachary S Zumsteg1,2. 1. Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA. 2. Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. 3. Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, California, USA. 4. Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California, USA. 5. Department of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA. 6. Tower Hematology Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA. 7. Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Abstract
BACKGROUND: Although pathologic tumor grade is a well-established prognostic risk factor that impacts staging and treatment decisions across multiple cancer types, its role in head and neck squamous cell carcinoma (HNSCC) is less certain. METHODS: HNSCC patients diagnosed from 2010 to 2015 and undergoing primary surgery in the National Cancer Data Base were identified. Propensity score matching and multivariable Cox regression were performed. RESULTS: Among 27 041 HNSCC patients, 13 941 had oral cavity cancers (OCC). Intermediate-grade (hazard ratio [HR] 1.16, 95% CI 1.07-1.26, P < .001) and high-grade (HR 1.38, 95% CI 1.26-1.52, P < .001) tumors had worse survival than low-grade tumors. This magnitude was comparable to other well-established prognostic factors, including margin positivity, extranodal extension, and lymphovascular invasion. By contrast, there was no association between grade and survival in larynx/hypopharynx or HPV(-) oropharynx cancer. CONCLUSIONS: The prognostic impact of pathologic grade is highly variable across head and neck subsites and is the strongest among OCC patients.
BACKGROUND: Although pathologic tumor grade is a well-established prognostic risk factor that impacts staging and treatment decisions across multiple cancer types, its role in head and neck squamous cell carcinoma (HNSCC) is less certain. METHODS: HNSCC patients diagnosed from 2010 to 2015 and undergoing primary surgery in the National Cancer Data Base were identified. Propensity score matching and multivariable Cox regression were performed. RESULTS: Among 27 041 HNSCC patients, 13 941 had oral cavity cancers (OCC). Intermediate-grade (hazard ratio [HR] 1.16, 95% CI 1.07-1.26, P < .001) and high-grade (HR 1.38, 95% CI 1.26-1.52, P < .001) tumors had worse survival than low-grade tumors. This magnitude was comparable to other well-established prognostic factors, including margin positivity, extranodal extension, and lymphovascular invasion. By contrast, there was no association between grade and survival in larynx/hypopharynx or HPV(-) oropharynx cancer. CONCLUSIONS: The prognostic impact of pathologic grade is highly variable across head and neck subsites and is the strongest among OCC patients.
Authors: Hosam H Alkhatib; Christopher A Maroun; Neha Amin; Gangcai Zhu; Meytal Guller; Matthew E Herberg; Evan S Wu; Tanguy Y Seiwert; Lisa M Rooper; David W Eisele; Carole Fakhry; Drew Pardoll; Rajarsi Mandal Journal: JAMA Otolaryngol Head Neck Surg Date: 2022-06-01 Impact factor: 8.961