Abstract
Background
The American Joint Committee on Cancer (AJCC) stage III classification of oral cavity squamous cell carcinoma (OCSCC) represents a heterogeneous group of patients with early local disease with regional metastases (T1N1 and T2N1) and advanced local disease with or without regional metastasis (T3N0 and T3N1).
Objective
The aim of this study was to evaluate prognostic heterogeneity in the stage III category.
Methods and Patients
An international retrospective multicenter study of 1815 patients who were treated for OCSCC from 2003 to 2011.
Results
Kaplan–Meier survival analysis and multivariate models of stage III patients revealed better overall survival (OS; HR 2.12, 95 % CI 1.03–4.15; p = 0.01) and disease-specific survival (DSS; HR 1.7, 95 % CI 1.16–4.12; p = 0.04) rates for patients with T1–2N1/T3N0 disease than for patients with T3N1 disease. The outcomes of patients with T3N1 and stage IVa disease were similar (p = 0.89 and p = 0.78 for OS and DSS, respectively). Modifying stage classification by transferring the T3N1 category to the stage VIa group resulted in a better prognostic performance [Harrell’s concordance index, C index 0.76; Akaike’s Information Criterion (AIC) 4131.6] compared with the AJCC 7th edition staging system (C index 0.65; AIC 4144.9) for OS. When DSS was assessed, the suggested staging system remained the best performing model (C index 0.71; AIC 1061.3) compared with the current AJCC 7th edition staging (C index 0.64; AIC 1066.2).
Conclusions
The prognosis of T3N1 and stage IVa disease are similar in OCSCC, suggesting that these categories could be combined in future revisions of the nodal staging system to enhance prognostic accuracy.
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References
Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011;61:212–36.
Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, eds. AJCC cancer staging manual. 7th ed. New York, NY: Springer; 2010.
Groome PA, Schulze K, Boysen M, Hall SF, Mackillop WJ. A comparison of published head and neck stage groupings in carcinomas of the oral cavity. Head Neck. 2001;23:613–24.
Manikantan K, Sayed SI, Syrigos KN, Rhys-Evans P, Nutting CM, Harrington KJ, et al. Challenges for the future modifications of the TNM staging system for head and neck cancer: case for a new computational model? Cancer Treat Rev. 2009;35:639–44.
Hall SF, Groome PA, Irish J, O’Sullivan B. TNM-based stage groupings in head and neck cancer: application in cancer of the hypopharynx. Head Neck. 2009;31:1–8.
Kreppel M, Drebber U, Rothamel D, Eich HT, Kübler A, Scheer M, et al. Prognostic impact of different TNM-based stage groupings for oral squamous cell carcinoma. Head Neck. 2011;33:1467–75.
Robbins KT, Shaha AR, Medina JE, Califano JA, Wolf GT, Ferlito A, et al. Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg. 2008;134:536–8.
Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–87.
Akaike H. New look at statistical-model identification. IEEE Trans Autom Control. 1982;19:716–23.
Shah JP, Gil Z. Current concepts in management of oral cancer: surgery. Oral Oncol. 2009;45:394–401.
Liao CT, Lin CY, Fan KH, Huang SF, Chen IH, Kang CJ, et al. Identification of a high-risk subgroup of patients with resected pT3 oral cavity cancer in need of postoperative adjuvant therapy. Ann Surg Oncol. 2011;18:2569–78.
Merritt RM, Williams MF, James TH, Porubsky ES. Detection of cervical metastasis: a meta-analysis comparing computed tomography with physical examination. Arch Otolaryngol Head Neck Surg. 1997;123:149–52.
Gil Z, Fliss DM. Contemporary management of head and neck cancers. Isr Med Assoc J. 2009;11:296–300.
Kyzas PA, Evangelou E, Denaxa-Kyza D, Ioannidis JP. 18F-fluorodeoxyglucose positron emission tomography to evaluate cervical node metastases in patients with head and neck squamous cell carcinoma: a meta-analysis. J Natl Cancer Inst. 2008;100:712–20.
Rudoltz MS, Benammar A, Mohiuddin M. Does pathologic node status affect local control in patients with carcinoma of the head and neck treated with radical surgery and postoperative radiotherapy? Int J Radiat Oncol Biol Phys. 1995;31:503–8.
Parsons JT, Mendenhall WM, Stringer SP, Cassisi NJ, Million RR. An analysis of factors influencing the outcome of postoperative irradiation for squamous cell carcinoma of the oral cavity. Int J Radiat Oncol Biol Phys. 1997;39:137–48.
Gavilan J, Prim MP, De Diego JI, Hardisson D, Pozuelo A. Postoperative radiotherapy in patients with positive nodes after functional neck dissection. Ann Otol Rhinol Laryngol. 2000;109:844–8.
Shingaki S, Takada M, Sasai K, Bibi R, Kobayashi T, Nomura T, et al. Impact of lymph node metastasis on the pattern of failure and survival in oral carcinomas. Am J Surg. 2003;185:278–84.
Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck. 2005;27:843–50.
Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004;350:1945–52.
Trimble EL, Abrams JS, Meyer RM, Calvo F, Cazap E, Deye J, et al. Improving cancer outcomes through international collaboration in academic cancer treatment trials. J Clin Oncol. 2009;27:5109–14.
Acknowledgments
The authors would like to thank Cindy Cohen for her editorial assistance.
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The authors have no conflicts of interest to declare.
Disclosures
This research was supported by the ICRF Barbara S. Goodman endowed research career development award (2011-601-BGPC) and a grant from the US–Israel Binational Science Foundation. The authors have no other financial disclosures.
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Amit, M., Yen, T.C., Liao, C.T. et al. Prognostic Performance of Current Stage III Oral Cancer Patients After Curative Intent Resection: Evidence to Support a Revision of the American Joint Committee on Cancer Staging System. Ann Surg Oncol 22 (Suppl 3), 985–991 (2015). https://doi.org/10.1245/s10434-015-4842-3
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DOI: https://doi.org/10.1245/s10434-015-4842-3