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Development and validation of a novel TNM staging N-classification of oral cavity squamous cell carcinoma.
de Almeida, John R; Su, Jie Susie; Kolarski, Mirko Manojlovic; Truong, Tra; Weinreb, Ilan; Perez-Ordonez, Bayardo; Smith, Stephen M; Hosni, Ali; Patel, Snehal; Valero, Cristina; Xu, Bin; Ghossein, Ronald; Katabi, Nora; Clark, Jonathan; Low, Tsu-Hui Hubert; Gupta, Ruta; Graboyes, Evan M; Davies, Joel; Richardson, Mary; Pasham, Vishu; Jester, Rachel; Goldstein, David P; Huang, Shao Hui; Xu, Wei; O'Sullivan, Brian.
Afiliação
  • de Almeida JR; Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada.
  • Su JS; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
  • Kolarski MM; Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
  • Truong T; Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada.
  • Weinreb I; Department of Otolaryngology-Head and Neck Surgery, Health Sciences North, Sudbury, Ontario, Canada.
  • Perez-Ordonez B; Department of Pathology, University Health Network, Toronto, Ontario, Canada.
  • Smith SM; Department of Pathology, University Health Network, Toronto, Ontario, Canada.
  • Hosni A; Department of Pathology, University Health Network, Toronto, Ontario, Canada.
  • Patel S; Department of Pathology, University Health Network, Toronto, Ontario, Canada.
  • Valero C; Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada.
  • Xu B; Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
  • Ghossein R; Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
  • Katabi N; Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
  • Clark J; Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
  • Low TH; Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
  • Gupta R; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
  • Graboyes EM; Sydney Medical School, Faculty of Medicine and Health Sciences, the University of Sydney, Sydney, New South Wales, Australia.
  • Davies J; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
  • Richardson M; Sydney Medical School, Faculty of Medicine and Health Sciences, the University of Sydney, Sydney, New South Wales, Australia.
  • Pasham V; Sydney Medical School, Faculty of Medicine and Health Sciences, the University of Sydney, Sydney, New South Wales, Australia.
  • Jester R; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, New South Wales, Australia.
  • Goldstein DP; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
  • Huang SH; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
  • Xu W; Department of Otolaryngology-Head and Neck Surgery, Sinai Health Systems, Toronto, Ontario, Canada.
  • O'Sullivan B; Department of Pathology, Medical University of South Carolina, Charleston, South Carolina, USA.
Cancer ; 130(3): 410-420, 2024 02 01.
Article em En | MEDLINE | ID: mdl-37751180
ABSTRACT

BACKGROUND:

For oral cavity squamous cell carcinoma (OSCC), extent of extranodal extension (ENE) (minor, ≤2 mm; major, >2 mm) is differentially prognostic, whereas limitations exist with the 8th edition of American Joint Committee on Cancer/International Union Against Cancer TNM N-classification (TNM-8-N).

METHODS:

Resected OSCC patients at four centers were included and extent of ENE was recorded. Thresholds for optimal overall survival (OS) discrimination of lymph node (LN) features were established. After dividing into training and validation sets, two new N-classifications were created using 1) recursive partitioning analysis (RPA), and 2) adjusted hazard ratios (aHRs) and were ranked against TNM-8-N and two published proposals.

RESULTS:

A total of 1460 patients were included (pN0 696; pN+ 764). Of the pN+ cases, 135 (18%) had bilateral/contralateral LNs; 126 (17%) and 244 (32%) had minor and major ENE, and two (0.3%) had LN(s) >6 cm without ENE (N3a). LN number (1 and >1 vs. 0 aHRs, 1.92 [95% confidence interval (CI), 1.44-2.55] and 3.21 [95% CI, 2.44-4.22]), size (>3 vs. ≤3 cm aHR, 1.88 [95% CI, 1.44-2.45]), and ENE extent (major vs. minor aHR, 1.40 [95% CI, 1.05-1.87]) were associated with OS, whereas presence of contralateral LNs was not (aHR, 1.05 [95% CI, 0.81-1.36]). The aHR proposal provided optimal performance with these changes to TNM-8-N 1) stratification of ENE extent, 2) elimination of N2c and 6-cm threshold, and 3) stratification of N2b by 3 cm threshold.

CONCLUSION:

A new N-classification improved staging performance compared to TNM-8-N, by stratifying by ENE extent, eliminating the old N2c category and the 6 cm threshold, and by stratifying multiple nodes by size.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Bucais / Carcinoma de Células Escamosas / Neoplasias de Cabeça e Pescoço Limite: Humans Idioma: En Revista: Cancer Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Canadá
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Bucais / Carcinoma de Células Escamosas / Neoplasias de Cabeça e Pescoço Limite: Humans Idioma: En Revista: Cancer Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Canadá