Number of nodal metastases and the American Joint Committee on cancer staging of head and neck cutaneous squamous cell carcinoma: A multicenter study.
Oral Oncol
; 111: 104855, 2020 12.
Article
em En
| MEDLINE
| ID: mdl-32835932
ABSTRACT
OBJECTIVES:
We aimed to determine if the number of nodal metastases is an independent predictor of survival in HNcSCC, whether it provides additional prognostic information to the AJCC N and TNM stage and identify optimal cut-points for risk stratification. MATERIALS ANDMETHODS:
Retrospective multi-institutional cohort study of patients with parotid and/or cervical nodal metastases from HNcSCC treated with curative intent by surgery⯱â¯adjuvant therapy. The impact of number of nodal metastases on disease-specific and overall survival was assessed using multivariate Cox regression. Optimal cut-points for prognostic discrimination modelled using the AIC, BIC, C-index and PVE.RESULTS:
The study cohort included 1128 patients, with 962 (85.3%) males, median age of 72.9â¯years (range 18-100â¯years) and median follow-up 3.4â¯years. Adjuvant radiotherapy was administered to 946 (83.9%) patients. Based on objective measures of model performance, number of nodal metastases was classified as 1-2 (Nâ¯=â¯816), 3-4 (Nâ¯=â¯162) and ≥5 (Nâ¯=â¯150) nodes. In multivariate analyses, the risk of disease-specific mortality progressively increased with 3-4 nodes (HR, 1.58; 95% CI 1.03-2.42; pâ¯=â¯0.036) and ≥5 nodes (HR, 2.91; 95% CI 1.99-4.25; pâ¯<â¯0.001) with similar results for all-cause mortality. This simple categorical variable provided superior prognostic information to the TNM stage.CONCLUSION:
Increasing number of nodal metastases is an independent predictor of mortality in HNcSCC, with categorization as 1-2, 3-4 and ≥5 nodes optimizing risk stratification and providing superior prognostic information to TNM stage. These findings may aid in the development of future staging systems as well as identification of high-risk patients in clinical trials.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Neoplasias Cutâneas
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Carcinoma de Células Escamosas de Cabeça e Pescoço
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Linfonodos
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Estadiamento de Neoplasias
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article