Moran Amit1, Chuan Liu1, Frederico O Gleber-Netto1, Sameer Kini1, Samantha Tam2, Avi Benov3,4, Mohamed Aashiq1, Adel K El-Naggar5, Amy C Moreno6, David I Rosenthal6, Bonnie S Glisson7, Renata Ferrarotto7, Michael K Wong8, Michael R Migden9, Erez N Baruch10, Guojun Li1, Anshu Khanna1, Ryan P Goepfert1, Priyadharsini Nagarajan5, Randal S Weber1, Jeffrey N Myers1, Neil D Gross1. 1. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas. 2. Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System and Henry Ford Cancer Institute, Detroit, Michigan. 3. Medical Corps, Israel Defense Forces, Tel Hasomer, Ramat Gan, Israel. 4. The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel. 5. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 6. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 7. Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 8. Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 9. Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 10. Program for Innovative Microbiome and Translational Research (PRIME-TR), The University of Texas MD Anderson Cancer Center, Houston, Texas.
Abstract
BACKGROUND: The prognostic performance of the recently updated American Joint Committee on Cancer lymph node classification of cutaneous head and neck squamous cell carcinoma (HNSCC) has not been validated. The objective of this study was to assess the prognostic role of extranodal extension (ENE) in cutaneous HNSCC. METHODS: This was a retrospective analysis of 1258 patients with cutaneous HNSCC who underwent surgery with or without adjuvant therapy between 1995 and 2019 at The University of Texas MD Anderson Cancer Center. The primary outcome was disease-specific survival (DSS). Local, regional, and distant metastases-free survival were secondary outcomes. Recursive partitioning analysis (RPA) and a Cox proportional hazards regression model were used to assess the fitness of staging models. RESULTS: No significant differences in 5-year DSS were observed between patients with pathologic lymph node-negative (pN0) disease (67.4%) and those with pN-positive/ENE-negative disease (68.2%; hazard ratio, 1.02; 95% CI, 0.61-1.79) or between patients with pN-positive/ENE-negative disease and those with pN-positive/ENE-positive disease (52.7%; hazard ratio, 0.57; 95% CI, 0.31-1.01). The RPA-derived model achieved better stratification between high-risk patients (category III, ENE-positive with >2 positive lymph nodes) and low-risk patients (category I, pN0; category II, ENE-positive/pN1 and ENE-negative with >2 positive lymph nodes). The performance of the RPA-derived model was better than that of the pathologic TNM classification (Akaike information criterion score, 1167 compared with 1176; Bayesian information criterion score, 1175 compared with 1195). CONCLUSIONS: The number of metastatic lymph nodes and the presence of ENE are independent prognostic factors for DSS in cutaneous HNSCC, and incorporation of these factors in staging systems improves the performance of the American Joint Committee on Cancer lymph node classification.
BACKGROUND: The prognostic performance of the recently updated American Joint Committee on Cancer lymph node classification of cutaneous head and neck squamous cell carcinoma (HNSCC) has not been validated. The objective of this study was to assess the prognostic role of extranodal extension (ENE) in cutaneous HNSCC. METHODS: This was a retrospective analysis of 1258 patients with cutaneous HNSCC who underwent surgery with or without adjuvant therapy between 1995 and 2019 at The University of Texas MD Anderson Cancer Center. The primary outcome was disease-specific survival (DSS). Local, regional, and distant metastases-free survival were secondary outcomes. Recursive partitioning analysis (RPA) and a Cox proportional hazards regression model were used to assess the fitness of staging models. RESULTS: No significant differences in 5-year DSS were observed between patients with pathologic lymph node-negative (pN0) disease (67.4%) and those with pN-positive/ENE-negative disease (68.2%; hazard ratio, 1.02; 95% CI, 0.61-1.79) or between patients with pN-positive/ENE-negative disease and those with pN-positive/ENE-positive disease (52.7%; hazard ratio, 0.57; 95% CI, 0.31-1.01). The RPA-derived model achieved better stratification between high-risk patients (category III, ENE-positive with >2 positive lymph nodes) and low-risk patients (category I, pN0; category II, ENE-positive/pN1 and ENE-negative with >2 positive lymph nodes). The performance of the RPA-derived model was better than that of the pathologic TNM classification (Akaike information criterion score, 1167 compared with 1176; Bayesian information criterion score, 1175 compared with 1195). CONCLUSIONS: The number of metastatic lymph nodes and the presence of ENE are independent prognostic factors for DSS in cutaneous HNSCC, and incorporation of these factors in staging systems improves the performance of the American Joint Committee on Cancer lymph node classification.
Authors: Raphael M Kronberg; Lena Haeberle; Melanie Pfaus; Haifeng C Xu; Karina S Krings; Martin Schlensog; Tilman Rau; Aleksandra A Pandyra; Karl S Lang; Irene Esposito; Philipp A Lang Journal: Cancers (Basel) Date: 2022-04-13 Impact factor: 6.575