TY - JOUR

T1 - Metrics of pN-staging in oral squamous cell carcinoma

T2 - An analysis of 1,905 patients

AU - Mirian, Christian

AU - Gerds, Thomas A.

AU - Pedersen, Maria M.

AU - Ridder, Mischa de

AU - Balm, Alfons

AU - Mattavelli, Davide

AU - Piazza, Cesare

AU - Jensen, Lasse R.

AU - Balasubramanian, Deepak

AU - Subramaniam, Narayana

AU - Dokhe, Yogesh

AU - Thankappan, Krishnakumar

AU - Iyer, Subramania

AU - Karam, Sana D.

AU - Wiegand, Susanne

AU - Feeley, Linda

AU - Milross, Chris

AU - Gao, Kan

AU - Palme, Carsten E.

AU - Low, Tsu-Hui (Hubert)

AU - Gupta, Ruta

AU - Freudlsperger, Christian

AU - Moratin, Julius

AU - Sheahan, Patrick

AU - Clark, Jonathan

AU - Ovesen, Therese

PY - 2021

Y1 - 2021

N2 - Background: We aimed to compare the predictive performance of pN-categories in oral squamous cell carcinoma (OSCC) encompassing the most recent 8th edition (TNM8), its predecessor (TNM7), and a newly proposed algorithm (pN-N+), which classifies patients according to the number of positive lymph nodes and extranodal extension.Methods: Consecutive, primary OSCC patients from seven previously published cohorts were included and classified according to the three pN-classifications: TNM7, TNM8 and pN-N+. Overall survival probabilities were summarised with the Kaplan -Meier method. We added each of the three metrics to a Cox regression adjusted for pT-category, lymph nodal yield, age, sex, radiotherapy and chemotherapy, and trained these models in one institution. We evaluated the predictive performance in the remaining six institutions and assessed the predicted 5-year risk of death using the area under the receiver operating characteristics curve (AUC) and Brier scores.Results: All 1,905 included patients were classified according to TNM7 and pN-N+. A subset of 1,575 patients was additionally classified according to TNM8, leading to upstaging in 27.0%. The pN-N+ ranked overall best determined by the obtained AUC and Brier scores. In contrast to pN-N+, TNM7 and TNM8 both suffered from disproportionate patient distribution across pN-categories and poor pN-categorial discrimination on overall survival.Conclusions: The TNM8 pN-classification designates a larger subset to more advanced disease stages but failed to show improvement of its predictive performance compared to TNM7. The pN-categories of TNM7/8 are disproportionate and inconsistently discriminated. The pN-N+ conveyed the best measures of prognosis and should be considered in future TNM iterations. (C) 2021 Elsevier Ltd. All rights reserved.

AB - Background: We aimed to compare the predictive performance of pN-categories in oral squamous cell carcinoma (OSCC) encompassing the most recent 8th edition (TNM8), its predecessor (TNM7), and a newly proposed algorithm (pN-N+), which classifies patients according to the number of positive lymph nodes and extranodal extension.Methods: Consecutive, primary OSCC patients from seven previously published cohorts were included and classified according to the three pN-classifications: TNM7, TNM8 and pN-N+. Overall survival probabilities were summarised with the Kaplan -Meier method. We added each of the three metrics to a Cox regression adjusted for pT-category, lymph nodal yield, age, sex, radiotherapy and chemotherapy, and trained these models in one institution. We evaluated the predictive performance in the remaining six institutions and assessed the predicted 5-year risk of death using the area under the receiver operating characteristics curve (AUC) and Brier scores.Results: All 1,905 included patients were classified according to TNM7 and pN-N+. A subset of 1,575 patients was additionally classified according to TNM8, leading to upstaging in 27.0%. The pN-N+ ranked overall best determined by the obtained AUC and Brier scores. In contrast to pN-N+, TNM7 and TNM8 both suffered from disproportionate patient distribution across pN-categories and poor pN-categorial discrimination on overall survival.Conclusions: The TNM8 pN-classification designates a larger subset to more advanced disease stages but failed to show improvement of its predictive performance compared to TNM7. The pN-categories of TNM7/8 are disproportionate and inconsistently discriminated. The pN-N+ conveyed the best measures of prognosis and should be considered in future TNM iterations. (C) 2021 Elsevier Ltd. All rights reserved.

KW - Oral oncology

KW - OSCC

KW - Head and neck oncology

KW - TNM

KW - AJCC

KW - Classification

KW - pN-staging

KW - Lymph nodal yield

KW - Lymph nodal density

KW - Epidemiology

KW - AMERICAN JOINT COMMITTEE

KW - LYMPH-NODE RATIO

KW - 8TH EDITION

KW - POSITIVE NODES

KW - CANCER

KW - HEAD

KW - SYSTEM

KW - PERFORMANCE

KW - PROGNOSIS

KW - NUMBER

U2 - 10.1016/j.ejca.2021.03.019

DO - 10.1016/j.ejca.2021.03.019

M3 - Journal article

C2 - 33887515

VL - 150

SP - 33

EP - 41

JO - European Journal of Cancer, Supplement

JF - European Journal of Cancer, Supplement

SN - 0959-8049

ER -