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

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 metastas...

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Bibliographic Details
Published in:Annals of surgical oncology 2015-12, Vol.22 (Suppl 3), p.985-991
Main Authors: Amit, M., Yen, T. C., Liao, C. T., Chaturvedi, P., Agarwal, J. P., Kowalski, L. P., Kohler, Hugo F., Ebrahimi, A., Clark, J. R., Cernea, C. R., Brandao, S. J., Kreppel, M., Zöller, J., Fliss, M. D., Bachar, G., Shpitzer, T., Bolzoni, V. A., Patel, P. R., Jonnalagadda, S., Robbins, K. T., Iyer, N. G., Skanthakumar, T., Shah, J. P., Patel, S. G., Gil, Z.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Carcinoma, Squamous Cell - pathology
Carcinoma, Squamous Cell - surgery
Female
Follow-Up Studies
Head and Neck Oncology
Humans
International Agencies
Male
Medicine
Medicine & Public Health
Middle Aged
Mouth Neoplasms - pathology
Mouth Neoplasms - surgery
Neoplasm Invasiveness
Neoplasm Staging - standards
Oncology
Prognosis
Retrospective Studies
Surgery
Surgical Oncology
Survival Rate
United States
Young Adult
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Summary: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.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-015-4842-3