Number of nodal metastases and the American Joint Committee on cancer staging of head and neck cutaneous squamous cell carcinoma: A multicenter study

Ardalan Ebrahimi; Ruta Gupta; Peter Luk; Tsu-Hui Hubert Low; Lachlan McDowell; Matthew J R Magarey; Paul N Smith; Diana M Perriman; Klaus-Martin Schulte; Michael Veness; Sandro V Porceddu; Jonathan R Clark

doi:10.1016/j.oraloncology.2020.104855

Number of nodal metastases and the American Joint Committee on cancer staging of head and neck cutaneous squamous cell carcinoma: A multicenter study

Oral Oncol. 2020 Dec:111:104855. doi: 10.1016/j.oraloncology.2020.104855. Epub 2020 Aug 21.

Authors

Affiliations

¹ Medical School, College of Health and Medicine, Australian National University, Canberra, Australia; Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Department of Head and Neck Surgery, The Canberra Hospital, Canberra, Australia. Electronic address: ardalan@specialistheadandneck.com.
² Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia.
³ Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia.
⁴ Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.
⁵ Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
⁶ Medical School, College of Health and Medicine, Australian National University, Canberra, Australia.
⁷ Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Radiation Oncology, Westmead Hospital, Sydney, Australia.
⁸ Faculty of Medicine, The University of Queensland, Brisbane, Australia; Radiation Oncology Department, Princess Alexandria Hospital, Brisbane, Australia.
⁹ Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia.

PMID: 32835932
DOI: 10.1016/j.oraloncology.2020.104855

Abstract

Objectives: We aimed to determine if the number of nodal metastases is an independent predictor of survival in HNcSCC, whether it provides additional prognostic information to the AJCC N and TNM stage and identify optimal cut-points for risk stratification.

Materials and methods: Retrospective multi-institutional cohort study of patients with parotid and/or cervical nodal metastases from HNcSCC treated with curative intent by surgery ± adjuvant therapy. The impact of number of nodal metastases on disease-specific and overall survival was assessed using multivariate Cox regression. Optimal cut-points for prognostic discrimination modelled using the AIC, BIC, C-index and PVE.

Results: The study cohort included 1128 patients, with 962 (85.3%) males, median age of 72.9 years (range: 18-100 years) and median follow-up 3.4 years. Adjuvant radiotherapy was administered to 946 (83.9%) patients. Based on objective measures of model performance, number of nodal metastases was classified as 1-2 (N = 816), 3-4 (N = 162) and ≥5 (N = 150) nodes. In multivariate analyses, the risk of disease-specific mortality progressively increased with 3-4 nodes (HR, 1.58; 95% CI: 1.03-2.42; p = 0.036) and ≥5 nodes (HR, 2.91; 95% CI: 1.99-4.25; p < 0.001) with similar results for all-cause mortality. This simple categorical variable provided superior prognostic information to the TNM stage.

Conclusion: Increasing number of nodal metastases is an independent predictor of mortality in HNcSCC, with categorization as 1-2, 3-4 and ≥5 nodes optimizing risk stratification and providing superior prognostic information to TNM stage. These findings may aid in the development of future staging systems as well as identification of high-risk patients in clinical trials.

Keywords: Cancer staging; Cutaneous squamous cell carcinoma; Head and neck cancer; Lymph node metastasis; Prognosis.

Publication types

Multicenter Study

MeSH terms

Adult
Advisory Committees
Aged
Aged, 80 and over
Female
Humans
Lymph Nodes / pathology*
Lymphatic Metastasis / pathology
Male
Middle Aged
Neck
Neoplasm Staging*
Parotid Neoplasms / secondary
Prognosis
Radiotherapy, Adjuvant / statistics & numerical data
Regression Analysis
Retrospective Studies
Risk Adjustment
Skin Neoplasms / mortality*
Skin Neoplasms / pathology*
Skin Neoplasms / therapy
Squamous Cell Carcinoma of Head and Neck / mortality*
Squamous Cell Carcinoma of Head and Neck / pathology*
Squamous Cell Carcinoma of Head and Neck / therapy
Young Adult