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Head and Neck Pathology

, Volume 7, Issue 3, pp 211–223 | Cite as

Validation of the Risk Model: High-Risk Classification and Tumor Pattern of Invasion Predict Outcome for Patients with Low-Stage Oral Cavity Squamous Cell Carcinoma

  • Yufeng Li
  • Shuting Bai
  • William Carroll
  • Dan Dayan
  • Joseph C. Dort
  • Keith Heller
  • George Jour
  • Harold Lau
  • Carla Penner
  • Michael Prystowsky
  • Eben Rosenthal
  • Nicolas F. Schlecht
  • Richard V. Smith
  • Mark Urken
  • Marilena Vered
  • Beverly Wang
  • Bruce Wenig
  • Abdissa Negassa
  • Margaret Brandwein-Gensler
Original Paper

Abstract

The Risk Model is a validated outcome predictor for patients with head and neck squamous cell carcinoma (Brandwein-Gensler et al. in Am J Surg Pathol 20:167–178, 2005; Am J Surg Pathol 34:676–688, 2010). This model may potentially shift treatment paradigms for patients with low-stage cancers, as current protocols dictate that they might receive only primary surgery. Here we test the hypothesis that the Risk Model has added prognostic value for low-stage oral cavity squamous cell carcinoma (OCSCC) patients. 299 patients with Stage I/II OCSCC were characterized according to the Risk Model (Brandwein-Gensler et al. in Am J Surg Pathol 20:167–178, 2005; Am J Surg Pathol 34:676–688, 2010). Cumulative incidence and competing risk analysis were performed for locoregional recurrence (LRR) and disease-specific survival (DSS). Receiver operating characteristic analyses were performed for worst pattern of invasion (WPOI) and the risk categories. 292 patients were analyzed; 30 T1N0 patients (17 %) and 26 T2N0 patients (23 %) developed LRR. Disease-specific mortality occurred in 9 T1N0 patients (6 %) and 9 T2N0 patients (10 %). On multivariable analysis, the Risk Model was significantly predictive of LRR (p = 0.0012, HR 2.41, 95 % CI 1.42, 4.11) and DSS (p = 0.0005, HR 9.16, 95 % CI 2.65, 31.66) adjusted for potential confounders. WPOI alone was also significantly predictive for LRR adjusted for potential confounders with a cut-point of either WPOI-4 (p = 0.0029, HR 3.63, 95 % CI 1.56, 8.47) or WPOI-5 (p = 0.0008, HR 2.55, 95 % CI 1.48, 4.41) and for DSS (cut point WPOI-5, p = 0.0001, HR 6.34, 95 % CI 2.50, 16.09). Given a WPOI-5, the probability of developing locoregional recurrence is 42 %. Given a high-risk classification for a combination of features other than WPOI-5, the probability of developing locoregional recurrence is 32 %. The Risk Model is the first validated model that is significantly predictive for the important niche group of low-stage OCSCC patients.

Keywords

Risk Model Low-stage Oral cavity Pattern of invasion Squamous cell carcinoma 

Notes

Acknowledgments

We thank the following surgeons: Mark DeLacure MD, David Myssiorek MD, and Kepal Patel MD, from New York University Langone Medical Center, and Rick Nason MD from University of Manitoba, Cancer Care Manitoba, Winnipeg, Canada for access to their patient medical records. We also thank Cathy Sarta, RN, for meticulous patient follow-up for the Montefiore Medical Center/Albert Einstein College of Medicine cohort.

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Yufeng Li
    • 8
  • Shuting Bai
    • 13
  • William Carroll
    • 9
  • Dan Dayan
    • 2
  • Joseph C. Dort
    • 3
  • Keith Heller
    • 4
  • George Jour
    • 5
  • Harold Lau
    • 3
  • Carla Penner
    • 6
  • Michael Prystowsky
    • 7
  • Eben Rosenthal
    • 15
  • Nicolas F. Schlecht
    • 12
  • Richard V. Smith
    • 10
  • Mark Urken
    • 11
  • Marilena Vered
    • 2
  • Beverly Wang
    • 14
  • Bruce Wenig
    • 5
  • Abdissa Negassa
    • 12
  • Margaret Brandwein-Gensler
    • 1
  1. 1.Departments of Pathology and SurgeryUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.The Maurice and Gabriela Goldschleger School of Dental MedicineTel-Aviv UniversityTel AvivIsrael
  3. 3.The Tom Baker Cancer CentreCalgaryCanada
  4. 4.Department of SurgeryNew York University Langone Medical CenterNew YorkUSA
  5. 5.Departments of Pathology and SurgeryContinuum Health Partners Beth Israel Medical CenterNew YorkUSA
  6. 6.Department of PathologyUniversity of Manitoba, Cancer Care ManitobaWinnipegCanada
  7. 7.Department of PathologyMontefiore Medical Center, Albert Einstein College of MedicineBronxUSA
  8. 8.Division of Preventive MedicineUniversity of Alabama at BirminghamBirminghamUSA
  9. 9.Department of Surgery, Section of Head and Neck OncologyUniversity of Alabama at BirminghamBirminghamUSA
  10. 10.Department of Otorhinolaryngology Head and Neck SurgeryMontefiore Medical Center, Albert Einstein College of MedicineBronxUSA
  11. 11.Department of SurgeryContinuum Health Partners Beth Israel Medical CenterNew YorkUSA
  12. 12.Departments of Epidemiology and Population Health, and MedicineMontefiore Medical Center, Albert Einstein College of MedicineBronxUSA
  13. 13.Department of PathologyUniversity of Alabama at BirminghamBirminghamUSA
  14. 14.Department of PathologyNew York University Langone Medical CenterNew YorkUSA
  15. 15.Department of Surgery, Division of OtolaryngologyUniversity of Alabama at BirminghamBirminghamUSA

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