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. 2022 Jun 28:12:910158.
doi: 10.3389/fonc.2022.910158. eCollection 2022.

Towards an Improved Pathological Node Classification for Prognostic Stratification of Patients With Oral Cavity Squamous Cell Carcinoma: Results From a Nationwide Registry Study

Chung-Jan Kang  1 , Yu-Wen Wen  2   3 , Shu-Ru Lee  4 , Shu-Hang Ng  5 , Chi-Ying Tsai  6 , Li-Yu Lee  7 , Ying-Hsia Chu  7 , Chien-Yu Lin  8 , Kang-Hsing Fan  8 , Hung-Ming Wang  9 , Chia-Hsun Hsieh  9 , Chih-Hua Yeh  5 , Chih-Hung Lin  10 , Chung-Kan Tsao  10 , Tuan-Jen Fang  1 , Shiang-Fu Huang  1 , Li-Ang Lee  1 , Ku-Hao Fang  1 , Yu-Chien Wang  1 , Wan-Ni Lin  1 , Li-Jen Hsin  1 , Tzu-Chen Yen  11 , Nai-Ming Cheng  11 , Chun-Ta Liao  1
Affiliations

Towards an Improved Pathological Node Classification for Prognostic Stratification of Patients With Oral Cavity Squamous Cell Carcinoma: Results From a Nationwide Registry Study

Chung-Jan Kang et al. Front Oncol. .

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.

Keywords: cancer registry; extra-nodal extension; log odds of positive lymph nodes; lymph node ratio; oral cavity squamous cell carcinoma; positive lymph nodes; survival outcomes.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow of patients through the study.
Figure 2
Figure 2
Adjusted hazard ratios for 5-year disease-specific survival and overall survival according to the lymph node ratio (A, B), the number of pathologically positive nodes (C, D), and the log odds of positive lymph nodes (E, F).
Figure 3
Figure 3
Kaplan-Meier plots of 5-year disease-specific survival and overall survival according to the lymph node ratio (A, B), the number of pathologically positive nodes (C, D), the log odds of positive lymph nodes (E, F), and the presence of extra-nodal extension (G, H).
Figure 4
Figure 4
Kaplan-Meier plots of 5-year disease-specific survival (A) and overall survival (B) according to the AJCC pN classification (pN1, pN2, pN3a, and pN3b). Kaplan-Meier plots of 5-year disease-specific survival (C) and overall survival (D) according to the scoring system devised in our study (scores: 0, 1, 2, and 3).
Figure 5
Figure 5
Kaplan-Meier plots of 5-year disease-specific survival (A) and overall survival (B) in patients with pN3b disease (AJCC pN classification) stratified according to a score of 1−3.
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