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Analysis and Comparison of the 8th Edition American Joint Committee on Cancer (AJCC) Nodal Staging System in Cutaneous and Oral Squamous Cell Cancer of the Head and Neck

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The American Joint Committee on Cancer (AJCC) uses the same nodal staging system for cutaneous and mucosal squamous cell carcinoma of the head and neck in its 8th edition (AJCC 8) despite differences in the etiology, risk factors, and clinical behavior of the two diseases. This study aims to evaluate the performance of the AJCC 8 nodal staging system by direct comparison of cutaneous (cSCC) versus oral squamous cell carcinoma (oSCC) patients.

Methods

Patients with metastatic cSCC (N = 382) and oSCC (N = 325) were identified from a prospective database (years 1987–2016). Multivariable analysis was performed using Cox proportional hazards competing risk model. To assess staging system performance, an explained variation measure (proportion of variation explained, PVE) as well as a discrimination measure (Harrell’s concordance index, C-index) were used.

Results

Inclusion of extranodal extension (ENE) in AJCC 8 increased the proportion of patients in N3b category (48.7% in cSCC, 40.3% in oSCC). AJCC 8 stratified poorly with regards to risk of death from cSCC and oSCC and showed limited monotonicity of the nodal categories. Estimates of model performance revealed modest predictive capacity for overall survival (OS) and disease-specific survival (DSS) in oSCC (Harrell’s C of 0.66 in both) and weak predictive capacity in cSCC (Harrell’s C of 0.58 and 0.61, respectively).

Conclusions

The AJCC 8 nodal staging system performs poorly in terms of stratifying survival by N category, especially in cSCC. The data indicate that cSCC merits an independent nodal staging system from that for mucosal SCC.

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Acknowledgment

We thank all patients who participated in this study.

Author information

Authors and Affiliations

  1. Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, Australia

    Nikolaus Moeckelmann MD, Richard Dirven MD, Tsu-Hui (Hubert) Low MBBS (Hons), FRACS, Sydney Ch’ng PhD, MBBS, FRACS, Carsten E. Palme MBBS, FRACS & Jonathan R. Clark MBBS, M Biostat, FRACS

  2. Department of Otolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Nikolaus Moeckelmann MD

  3. Department of Head and Neck Surgery, Liverpool Hospital, Liverpool, NSW, Australia

    Ardalan Ebrahimi MBBS (Hons), FRACS

  4. Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia

    Jessica Liu MBBS & Ruta Gupta MD, MBBS, FRCPA

  5. Central Clinical School, University of Sydney, Sydney, Australia

    Tsu-Hui (Hubert) Low MBBS (Hons), FRACS, Ruta Gupta MD, MBBS, FRCPA, Sydney Ch’ng PhD, MBBS, FRACS, Carsten E. Palme MBBS, FRACS & Jonathan R. Clark MBBS, M Biostat, FRACS

  6. School of Biological Sciences, University of Wollongong, Wollongong, Australia

    Bruce Ashford BDSc (Hons), MBBS, FRACS

  7. Illawarra Health and Medical Research Institute (IHMRI), Wollongong, Australia

    Bruce Ashford BDSc (Hons), MBBS, FRACS

  8. Illawarra and Shoalhaven Local Health District (ISLHD), Wollongong, Australia

    Bruce Ashford BDSc (Hons), MBBS, FRACS

  9. Centre for Oncology Education and Research Translation (CONCERT), Liverpool, Australia

    Bruce Ashford BDSc (Hons), MBBS, FRACS

  10. South West Clinical School, University of New South Wales, Sydney, Australia

    Jonathan R. Clark MBBS, M Biostat, FRACS

Authors
  1. Nikolaus Moeckelmann MD
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  2. Ardalan Ebrahimi MBBS (Hons), FRACS
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  3. Richard Dirven MD
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  4. Jessica Liu MBBS
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  5. Tsu-Hui (Hubert) Low MBBS (Hons), FRACS
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  6. Ruta Gupta MD, MBBS, FRCPA
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  7. Bruce Ashford BDSc (Hons), MBBS, FRACS
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  8. Sydney Ch’ng PhD, MBBS, FRACS
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  9. Carsten E. Palme MBBS, FRACS
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  10. Jonathan R. Clark MBBS, M Biostat, FRACS
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Corresponding author

Correspondence to Nikolaus Moeckelmann MD.

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Moeckelmann, N., Ebrahimi, A., Dirven, R. et al. Analysis and Comparison of the 8th Edition American Joint Committee on Cancer (AJCC) Nodal Staging System in Cutaneous and Oral Squamous Cell Cancer of the Head and Neck. Ann Surg Oncol 25, 1730–1736 (2018). https://doi.org/10.1245/s10434-018-6340-x

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  • DOI: https://doi.org/10.1245/s10434-018-6340-x

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