A critical analysis of the 8th edition TNM staging for head and neck cutaneous squamous cell carcinoma with lymph node metastases and comparison to N1S3 stage and ITEM risk score: A multicenter study.
cancer staging
cutaneous squamous cell carcinoma
head and neck cancer
lymph node metastasis
prognosis
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
revised:
16
09
2020
received:
29
05
2020
accepted:
22
09
2020
pubmed:
16
3
2021
medline:
5
6
2021
entrez:
15
3
2021
Statut:
ppublish
Résumé
We performed a critical analysis of the 8th edition American Joint Committee on Cancer (AJCC) staging for head and neck cutaneous squamous cell carcinoma (HNcSCC) with nodal metastases and compared the performance to the N1S3 and ITEM systems. Multicenter study of 990 patients with metastatic HNcSCC treated with curative intent. The end points of interest were disease-specific (DSS) and overall survival (OS). Model fit was evaluated using Harrell's Concordance Index (C-index), proportion of variation explained (PVE), Akaike information criterion, and Bayesian information criterion. N1S3 and ITEM demonstrated good distribution into risk categories in contrast to the AJCC system, which classified the majority (90.6%) of patients as N2-3 and Stage IV due to the high rate of extranodal extension. The N2c and N3a categories appeared redundant. There was considerable discordance between systems in risk allocation on an individual patient basis. N1S3 was the best performed (DSS: C-index 0.62, PVE 10.9%; OS: C-index 0.59, PVE 4.5%), albeit with relatively poor predictive value. The AJCC N category and tumor node metastasis stage have poor patient distribution and predictive performance in HNcSCC. The AJCC stage, N1S3, and ITEM score all provide limited prognostic information based on objective measures highlighting the need to develop a staging system specific to HNcSCC.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
We performed a critical analysis of the 8th edition American Joint Committee on Cancer (AJCC) staging for head and neck cutaneous squamous cell carcinoma (HNcSCC) with nodal metastases and compared the performance to the N1S3 and ITEM systems.
METHODS
METHODS
Multicenter study of 990 patients with metastatic HNcSCC treated with curative intent. The end points of interest were disease-specific (DSS) and overall survival (OS). Model fit was evaluated using Harrell's Concordance Index (C-index), proportion of variation explained (PVE), Akaike information criterion, and Bayesian information criterion.
RESULTS
RESULTS
N1S3 and ITEM demonstrated good distribution into risk categories in contrast to the AJCC system, which classified the majority (90.6%) of patients as N2-3 and Stage IV due to the high rate of extranodal extension. The N2c and N3a categories appeared redundant. There was considerable discordance between systems in risk allocation on an individual patient basis. N1S3 was the best performed (DSS: C-index 0.62, PVE 10.9%; OS: C-index 0.59, PVE 4.5%), albeit with relatively poor predictive value.
CONCLUSIONS
CONCLUSIONS
The AJCC N category and tumor node metastasis stage have poor patient distribution and predictive performance in HNcSCC. The AJCC stage, N1S3, and ITEM score all provide limited prognostic information based on objective measures highlighting the need to develop a staging system specific to HNcSCC.
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1531-1539Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012;166(5):1069-1080.
Alam M, Ratner D. Cutaneous squamous-cell carcinoma. N Engl J Med. 2001;344(13):975-983.
Ch'ng S, Maitra A, Allison RS, et al. Parotid and cervical nodal status predict prognosis for patients with head and neck metastatic cutaneous squamous cell carcinoma. J Surg Oncol. 2008;98(2):101-105.
Hirshoren N, Danne J, Dixon BJ, et al. Prognostic markers in metastatic cutaneous squamous cell carcinoma of the head and neck. Head Neck. 2017;39(4):772-778.
Schmidt C, Martin JM, Khoo E, Plank A, Grigg R. Outcomes of nodal metastatic cutaneous squamous cell carcinoma of the head and neck treated in a regional center. Head Neck. 2015;37(12):1808-1815.
Veness MJ, Palme CE, Morgan GJ. High-risk cutaneous squamous cell carcinoma of the head and neck: results from 266 treated patients with metastatic lymph node disease. Cancer. 2006;106(11):2389-2396.
Ebrahimi A, Clark JR, Lorincz BB, Milross CG, Veness MJ. Metastatic head and neck cutaneous squamous cell carcinoma: defining a low-risk patient. Head Neck. 2012;34(3):365-370.
Amin MB, E. S., Green FL, et al., editors. AJCC Cancer Staging Manual. 8th ed. New York: Springer; 2017.
Liu J, Ebrahimi A, Low THH, et al. Predictive value of the 8th edition American Joint Commission Cancer (AJCC) nodal staging system for patients with cutaneous squamous cell carcinoma of the head and neck. J Surg Oncol. 2018;117(4):765-772.
Sood A, Wykes J, Roshan D, et al. A critical analysis of the prognostic performance of the 8th edition American Joint Committee on Cancer staging for metastatic cutaneous squamous cell carcinoma of the head and neck. Head Neck. 2019;41:1591-1596.
O'Brien CJ, McNeil EB, McMahon JD, Pathak I, Lauer CS, Jackson MA. Significance of clinical stage, extent of surgery, and pathologic findings in metastatic cutaneous squamous carcinoma of the parotid gland. Head Neck. 2002;24(5):417-422.
Forest VI, Clark JJ, Veness MJ, Milross C. N1S3: a revised staging system for head and neck cutaneous squamous cell carcinoma with lymph node metastases: results of 2 Australian Cancer Centers. Cancer. 2010;116(5):1298-1304.
Oddone N, Morgan GJ, Palme CE, et al. Metastatic cutaneous squamous cell carcinoma of the head and neck: the immunosuppression, treatment, extranodal spread, and margin status (ITEM) prognostic score to predict outcome and the need to improve survival. Cancer. 2009;115(9):1883-1891.
McLean T, Brunner M, Ebrahimi A, et al. Concurrent primary and metastatic cutaneous head and neck squamous cell carcinoma: analysis of prognostic factors. Head Neck. 2013;35(8):1144-1148.
Hasmat S, Mooney C, Gao K, et al. Regional metastasis in head and neck cutaneous squamous cell carcinoma: an update on the significance of extra-nodal extension and soft tissue metastasis. Ann Surg Oncol. 2020;27:2840-2845.
Ch'ng S, Clark JR, Brunner M, Palme CE, Morgan GJ, Veness MJ. Relevance of the primary lesion in the prognosis of metastatic cutaneous squamous cell carcinoma. Head Neck. 2013;35(2):190-194.
Lam JKS, Sundaresan P, Gebski V, Veness MJ. Immunocompromised patients with metastatic cutaneous nodal squamous cell carcinoma of the head and neck: poor outcome unrelated to the index lesion. Head Neck. 2018;40(5):985-992.
Ebrahimi A, Moncrieff MD, Clark JR, et al. Predicting the pattern of regional metastases from cutaneous squamous cell carcinoma of the head and neck based on location of the primary. Head Neck. 2010;32(10):1288-1294.
Karia PS, Morgan FC, Califano JA, Schmults CD. Comparison of tumor classifications for cutaneous squamous cell carcinoma of the head and neck in the 7th vs 8th edition of the AJCC Cancer Staging Manual. JAMA Dermatol. 2018;154(2):175-181.
Cañueto J, Burguillo J, Moyano-Bueno D, et al. Comparing the eighth and the seventh editions of the American Joint Committee on Cancer staging system and the Brigham and Women's Hospital alternative staging system for cutaneous squamous cell carcinoma: implications for clinical practice. J Am Acad Dermatol. 2019;80(1):106-113 e2.
Schemper M, Stare J. Explained variation in survival analysis. Stat Med. 1996;15(19):1999-2012.
Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15(4):361-387.
Akaike H. New look at statistical-model identification. IEEE Trans Automat Contr. 1982;19:716-723.
Kelder W, Ebrahimi A, Forest VI, Gao K, Murali R, Clark JR. Cutaneous head and neck squamous cell carcinoma with regional metastases: the prognostic importance of soft tissue metastases and extranodal spread. Ann Surg Oncol. 2012;19(1):274-279.
Lydiatt W, O'Sullivan B, Patel S. Major changes in head and neck staging for 2018. Am Soc Clin Oncol Educ Book. 2018;(38):505-514.
Prabhu RS, Hanasoge S, Magliocca KR, et al. Extent of pathologic extracapsular extension and outcomes in patients with nonoropharyngeal head and neck cancer treated with initial surgical resection. Cancer. 2014;120(10):1499-1506.
Ebrahimi A, Gil Z, Amit M, et al. The prognosis of N2b and N2c lymph node disease in oral squamous cell carcinoma is determined by the number of metastatic lymph nodes rather than laterality: evidence to support a revision of the American Joint Committee on Cancer staging system. Cancer. 2014;120(13):1968-1974.
Moeckelmann N, Ebrahimi A, Tou YK, et al. Prognostic implications of the 8th edition American Joint Committee on Cancer (AJCC) staging system in oral cavity squamous cell carcinoma. Oral Oncol. 2018;85:82-86.
Wong RX, Wong FY, Lim J, Lian WX, Yap YS. Validation of the AJCC 8th prognostic system for breast cancer in an Asian healthcare setting. Breast. 2018;40:38-44.
Abdel-Rahman O. Validation of the 8th AJCC staging system for gastric cancer in a population-based setting. Expert Rev Gastroenterol Hepatol. 2018;12(5):525-530.
Su Z, Duan Z, Pan W, et al. Predicting extracapsular spread of head and neck cancers using different imaging techniques: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2016;45(4):413-421.