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 -