. 2024 Feb 1;130(3):410-420.

doi: 10.1002/cncr.35020. Epub 2023 Sep 26.

Development and validation of a novel TNM staging N-classification of oral cavity squamous cell carcinoma

John R de Almeida^{1

2}, Jie Susie Su³, Mirko Manojlovic Kolarski^{1

4}, Tra Truong⁵, Ilan Weinreb⁵, Bayardo Perez-Ordonez⁵, Stephen M Smith⁵, Ali Hosni⁶, Snehal Patel⁷, Cristina Valero⁷, Bin Xu⁸, Ronald Ghossein⁸, Nora Katabi⁸, Jonathan Clark^{9

10}, Tsu-Hui Hubert Low^{9

10}, Ruta Gupta^{10

11}, Evan M Graboyes¹², Joel Davies^{12

13}, Mary Richardson¹⁴, Vishu Pasham¹⁴, Rachel Jester¹⁴, David P Goldstein¹, Shao Hui Huang^{1

6}, Wei Xu³, Brian O'Sullivan^{1

6

15}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada.
² Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
³ Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
⁴ Department of Otolaryngology-Head and Neck Surgery, Health Sciences North, Sudbury, Ontario, Canada.
⁵ Department of Pathology, University Health Network, Toronto, Ontario, Canada.
⁶ Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada.
⁷ Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
⁸ Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
⁹ Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
¹⁰ Sydney Medical School, Faculty of Medicine and Health Sciences, the University of Sydney, Sydney, New South Wales, Australia.
¹¹ Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, New South Wales, Australia.
¹² Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
¹³ Department of Otolaryngology-Head and Neck Surgery, Sinai Health Systems, Toronto, Ontario, Canada.
¹⁴ Department of Pathology, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁵ Department of Radiation Oncology, Centre Hospitalier de L'University de Montreal, Montreal, Quebec, Canada.

PMID: 37751180
DOI: 10.1002/cncr.35020

Free article

Development and validation of a novel TNM staging N-classification of oral cavity squamous cell carcinoma

John R de Almeida et al. Cancer. 2024.

Free article

. 2024 Feb 1;130(3):410-420.

doi: 10.1002/cncr.35020. Epub 2023 Sep 26.

Authors

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada.
² Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
³ Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
⁴ Department of Otolaryngology-Head and Neck Surgery, Health Sciences North, Sudbury, Ontario, Canada.
⁵ Department of Pathology, University Health Network, Toronto, Ontario, Canada.
⁶ Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada.
⁷ Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
⁸ Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
⁹ Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
¹⁰ Sydney Medical School, Faculty of Medicine and Health Sciences, the University of Sydney, Sydney, New South Wales, Australia.
¹¹ Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, New South Wales, Australia.
¹² Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
¹³ Department of Otolaryngology-Head and Neck Surgery, Sinai Health Systems, Toronto, Ontario, Canada.
¹⁴ Department of Pathology, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁵ Department of Radiation Oncology, Centre Hospitalier de L'University de Montreal, Montreal, Quebec, Canada.

PMID: 37751180
DOI: 10.1002/cncr.35020

Abstract

Background: For oral cavity squamous cell carcinoma (OSCC), extent of extranodal extension (ENE) (minor, ≤2 mm; major, >2 mm) is differentially prognostic, whereas limitations exist with the 8th edition of American Joint Committee on Cancer/International Union Against Cancer TNM N-classification (TNM-8-N).

Methods: Resected OSCC patients at four centers were included and extent of ENE was recorded. Thresholds for optimal overall survival (OS) discrimination of lymph node (LN) features were established. After dividing into training and validation sets, two new N-classifications were created using 1) recursive partitioning analysis (RPA), and 2) adjusted hazard ratios (aHRs) and were ranked against TNM-8-N and two published proposals.

Results: A total of 1460 patients were included (pN0: 696; pN+: 764). Of the pN+ cases, 135 (18%) had bilateral/contralateral LNs; 126 (17%) and 244 (32%) had minor and major ENE, and two (0.3%) had LN(s) >6 cm without ENE (N3a). LN number (1 and >1 vs. 0: aHRs, 1.92 [95% confidence interval (CI), 1.44-2.55] and 3.21 [95% CI, 2.44-4.22]), size (>3 vs. ≤3 cm: aHR, 1.88 [95% CI, 1.44-2.45]), and ENE extent (major vs. minor: aHR, 1.40 [95% CI, 1.05-1.87]) were associated with OS, whereas presence of contralateral LNs was not (aHR, 1.05 [95% CI, 0.81-1.36]). The aHR proposal provided optimal performance with these changes to TNM-8-N: 1) stratification of ENE extent, 2) elimination of N2c and 6-cm threshold, and 3) stratification of N2b by 3 cm threshold.

Conclusion: A new N-classification improved staging performance compared to TNM-8-N, by stratifying by ENE extent, eliminating the old N2c category and the 6 cm threshold, and by stratifying multiple nodes by size.

Keywords: N classification; extent of extranodal extension; extranodal extension; number of nodes; oral cancer; staging.

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Comment in

Cancer staging: The Goldilocks principle.
Lydiatt WM. Lydiatt WM. Cancer. 2024 Feb 1;130(3):342-343. doi: 10.1002/cncr.35117. Epub 2023 Nov 15. Cancer. 2024. PMID: 37966345 No abstract available.

References

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Development and validation of a novel TNM staging N-classification of oral cavity squamous cell carcinoma

Affiliations

Development and validation of a novel TNM staging N-classification of oral cavity squamous cell carcinoma

Authors

Affiliations

Abstract

Comment in

References

REFERENCES

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical