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- Title
Towards an Improved Pathological Node Classification for Prognostic Stratification of Patients With Oral Cavity Squamous Cell Carcinoma: Results From a Nationwide Registry Study.
- Authors
Kang, Chung-Jan; Wen, Yu-Wen; Lee, Shu-Ru; Ng, Shu-Hang; Tsai, Chi-Ying; Lee, Li-Yu; Chu, Ying-Hsia; Lin, Chien-Yu; Fan, Kang-Hsing; Wang, Hung-Ming; Hsieh, Chia-Hsun; Yeh, Chih-Hua; Lin, Chih-Hung; Tsao, Chung-Kan; Fang, Tuan-Jen; Huang, Shiang-Fu; Lee, Li-Ang; Fang, Ku-Hao; Wang, Yu-Chien; Lin, Wan-Ni
- Abstract
Background: To assess the prognostic significance of different nodal parameters [i.e., number of pathologically positive nodes, log odds of positive lymph nodes, lymph node ratio (LNR), and extra-nodal extension (ENE)] in Taiwanese patients with oral cavity squamous cell carcinoma (OCSCC), and to devise an optimized pN classification system for predicting survival in OCSCC. Methods: A total of 4287 Taiwanese patients with first primary OCSCC and nodal metastases were enrolled. Cox proportional hazards regression analysis with the spline method was applied to identify the optimal cut-off values for LNR, log odds of positive lymph nodes, and number of pathologically positive nodes. Results: On multivariable analysis, we identified a LNR ≥0.078/0.079, the presence of at least three pathologically positive nodes, and ENE as independent prognosticators for 5-year disease-specific survival (DSS) and overall survival (OS) rates. We therefore devised a four-point prognostic scoring system according to the presence or absence of each variable. The 5-year DSS and OS rates of patients with scores of 0−3 were 70%/62%/50%/36% (p < 0.0001) and 61%/52%/40%25%, respectively (p < 0.0001). On analyzing the AJCC 2017 pN classification, patients with pN3a displayed better survival rates than those with pN2 disease. The 5-year DSS and OS rates of patients with pN1/pN2/pN3a/pN3b disease were 72%/60%/67%/43% (p < 0.0001) and 63%/51%/67%/33%, respectively (p < 0.0001). Conclusions: Three nodal parameters (i.e., a LNR ≥0.078/0.079, the presence of at least three pathologically positive nodes, and ENE) assessed in combination provided a better prognostic stratification than the traditional AJCC pN classification.
- Subjects
SQUAMOUS cell carcinoma; LYMPH nodes; REGRESSION analysis
- Publication
Frontiers in Oncology, 2022, Vol 12, p1
- ISSN
2234-943X
- Publication type
Article
- DOI
10.3389/fonc.2022.910158