Improving accuracy in nodal staging of oral cancer: Proposal of a new system

Narayana Subramaniam; Gillian Heller; Jonathan Robert Clark; Ruta Gupta; David Goldstein; John R. de Almeida; Ali Hosni; Deepak Balasubramanian; Krishnakumar Thankappan; Subramania Iyer; Martin Batstone; N. Gopal Iyer; Robert I. Smee; Naveen Hedne Chandrasekhar; Vijay Pillai; Vivek Shetty; Vidyabhushan Rangappa; Michael Veness; Tsu-Hui (Hubert) Low

doi:10.1016/j.suronc.2024.102033

Improving accuracy in nodal staging of oral cancer: Proposal of a new system

Narayana Subramaniam^*, Gillian Heller, Jonathan Robert Clark, Ruta Gupta, David Goldstein, John R. de Almeida, Ali Hosni, Deepak Balasubramanian, Krishnakumar Thankappan, Subramania Iyer, Martin Batstone, N. Gopal Iyer, Robert I. Smee, Naveen Hedne Chandrasekhar, Vijay Pillai, Vivek Shetty, Vidyabhushan Rangappa, Michael Veness, Tsu-Hui (Hubert) Low

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

Background: Despite introduction of extranodal extension (ENE) into the AJCC 8th edition of oral cancer staging, previous criticisms persist, such as limited discrimination between sub-stages and doubtful prognostic value of contralateral nodal disease. The purpose of this study was to compare our novel nodal staging system, based on the number of positive nodes and ENE, to the AJCC staging system in surgically treated patients.

Methods: Retrospective analysis of 4710 patients with oral squamous cell carcinoma (OSCC) treated with surgery±adjuvant therapy in 8 institutions in Australia, North America and Asia. With overall survival (OS) and disease specific survival (DSS) as endpoint, the prognostic performance of AJCC 8th and 7th editions were compared using hazard consistency, hazard discrimination, likelihood difference and balance.

Results: Our new nodal staging system (PN) a progressive and linear increase in hazard ratio (HR) from pN0 to pN3, with good separation of Kaplan Meier curves. Using the predetermined criteria for evaluation of a staging system, our proposed staging model outperformed AJCC 8th and 7th editions in prediction of OS and DSS.

Conclusion: PN was the lymph node staging system that provided the most accurate prediction of OS and DSS for patients in our cohort of OSCC. Additionally, it can be easily adopted, addresses the shortcomings of the existing systems and should be considered for future editions of the TNM staging system.

Original language	English
Article number	102033
Pages (from-to)	1-7
Number of pages	7
Journal	Surgical Oncology
Volume	52
DOIs	https://doi.org/10.1016/j.suronc.2024.102033
Publication status	Published - Feb 2024
Externally published	Yes

Keywords

AJCC 8th edition
Lymph nodes
Mouth neoplasms
Squamous cell carcinoma of the head and neck
Survival

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10.1016/j.suronc.2024.102033

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Subramaniam, N., Heller, G., Clark, J. R., Gupta, R., Goldstein, D., de Almeida, J. R., Hosni, A., Balasubramanian, D., Thankappan, K., Iyer, S., Batstone, M., Iyer, N. G., Smee, R. I., Chandrasekhar, N. H., Pillai, V., Shetty, V., Rangappa, V., Veness, M., & Low, T.-H. (2024). Improving accuracy in nodal staging of oral cancer: Proposal of a new system. Surgical Oncology, 52, 1-7. Article 102033. https://doi.org/10.1016/j.suronc.2024.102033

@article{517a2baa95ca4dfc8d68ac73c6b25c63,

title = "Improving accuracy in nodal staging of oral cancer: Proposal of a new system",

abstract = "Background: Despite introduction of extranodal extension (ENE) into the AJCC 8th edition of oral cancer staging, previous criticisms persist, such as limited discrimination between sub-stages and doubtful prognostic value of contralateral nodal disease. The purpose of this study was to compare our novel nodal staging system, based on the number of positive nodes and ENE, to the AJCC staging system in surgically treated patients.Methods: Retrospective analysis of 4710 patients with oral squamous cell carcinoma (OSCC) treated with surgery±adjuvant therapy in 8 institutions in Australia, North America and Asia. With overall survival (OS) and disease specific survival (DSS) as endpoint, the prognostic performance of AJCC 8th and 7th editions were compared using hazard consistency, hazard discrimination, likelihood difference and balance.Results: Our new nodal staging system (PN) a progressive and linear increase in hazard ratio (HR) from pN0 to pN3, with good separation of Kaplan Meier curves. Using the predetermined criteria for evaluation of a staging system, our proposed staging model outperformed AJCC 8th and 7th editions in prediction of OS and DSS.Conclusion: PN was the lymph node staging system that provided the most accurate prediction of OS and DSS for patients in our cohort of OSCC. Additionally, it can be easily adopted, addresses the shortcomings of the existing systems and should be considered for future editions of the TNM staging system.",

keywords = "AJCC 8th edition, Lymph nodes, Mouth neoplasms, Squamous cell carcinoma of the head and neck, Survival",

author = "Narayana Subramaniam and Gillian Heller and Clark, \{Jonathan Robert\} and Ruta Gupta and David Goldstein and \{de Almeida\}, \{John R.\} and Ali Hosni and Deepak Balasubramanian and Krishnakumar Thankappan and Subramania Iyer and Martin Batstone and Iyer, \{N. Gopal\} and Smee, \{Robert I.\} and Chandrasekhar, \{Naveen Hedne\} and Vijay Pillai and Vivek Shetty and Vidyabhushan Rangappa and Michael Veness and Low, \{Tsu-Hui (Hubert)\}",

year = "2024",

month = feb,

doi = "10.1016/j.suronc.2024.102033",

language = "English",

volume = "52",

pages = "1--7",

journal = "Surgical Oncology",

issn = "0960-7404",

publisher = "Elsevier",

}

Subramaniam, N, Heller, G, Clark, JR, Gupta, R, Goldstein, D, de Almeida, JR, Hosni, A, Balasubramanian, D, Thankappan, K, Iyer, S, Batstone, M, Iyer, NG, Smee, RI, Chandrasekhar, NH, Pillai, V, Shetty, V, Rangappa, V, Veness, M & Low, T-H 2024, 'Improving accuracy in nodal staging of oral cancer: Proposal of a new system', Surgical Oncology, vol. 52, 102033, pp. 1-7. https://doi.org/10.1016/j.suronc.2024.102033

TY - JOUR

T1 - Improving accuracy in nodal staging of oral cancer

T2 - Proposal of a new system

AU - Subramaniam, Narayana

AU - Heller, Gillian

AU - Clark, Jonathan Robert

AU - Gupta, Ruta

AU - Goldstein, David

AU - de Almeida, John R.

AU - Hosni, Ali

AU - Balasubramanian, Deepak

AU - Thankappan, Krishnakumar

AU - Iyer, Subramania

AU - Batstone, Martin

AU - Iyer, N. Gopal

AU - Smee, Robert I.

AU - Chandrasekhar, Naveen Hedne

AU - Pillai, Vijay

AU - Shetty, Vivek

AU - Rangappa, Vidyabhushan

AU - Veness, Michael

AU - Low, Tsu-Hui (Hubert)

PY - 2024/2

Y1 - 2024/2

N2 - Background: Despite introduction of extranodal extension (ENE) into the AJCC 8th edition of oral cancer staging, previous criticisms persist, such as limited discrimination between sub-stages and doubtful prognostic value of contralateral nodal disease. The purpose of this study was to compare our novel nodal staging system, based on the number of positive nodes and ENE, to the AJCC staging system in surgically treated patients.Methods: Retrospective analysis of 4710 patients with oral squamous cell carcinoma (OSCC) treated with surgery±adjuvant therapy in 8 institutions in Australia, North America and Asia. With overall survival (OS) and disease specific survival (DSS) as endpoint, the prognostic performance of AJCC 8th and 7th editions were compared using hazard consistency, hazard discrimination, likelihood difference and balance.Results: Our new nodal staging system (PN) a progressive and linear increase in hazard ratio (HR) from pN0 to pN3, with good separation of Kaplan Meier curves. Using the predetermined criteria for evaluation of a staging system, our proposed staging model outperformed AJCC 8th and 7th editions in prediction of OS and DSS.Conclusion: PN was the lymph node staging system that provided the most accurate prediction of OS and DSS for patients in our cohort of OSCC. Additionally, it can be easily adopted, addresses the shortcomings of the existing systems and should be considered for future editions of the TNM staging system.

AB - Background: Despite introduction of extranodal extension (ENE) into the AJCC 8th edition of oral cancer staging, previous criticisms persist, such as limited discrimination between sub-stages and doubtful prognostic value of contralateral nodal disease. The purpose of this study was to compare our novel nodal staging system, based on the number of positive nodes and ENE, to the AJCC staging system in surgically treated patients.Methods: Retrospective analysis of 4710 patients with oral squamous cell carcinoma (OSCC) treated with surgery±adjuvant therapy in 8 institutions in Australia, North America and Asia. With overall survival (OS) and disease specific survival (DSS) as endpoint, the prognostic performance of AJCC 8th and 7th editions were compared using hazard consistency, hazard discrimination, likelihood difference and balance.Results: Our new nodal staging system (PN) a progressive and linear increase in hazard ratio (HR) from pN0 to pN3, with good separation of Kaplan Meier curves. Using the predetermined criteria for evaluation of a staging system, our proposed staging model outperformed AJCC 8th and 7th editions in prediction of OS and DSS.Conclusion: PN was the lymph node staging system that provided the most accurate prediction of OS and DSS for patients in our cohort of OSCC. Additionally, it can be easily adopted, addresses the shortcomings of the existing systems and should be considered for future editions of the TNM staging system.

KW - AJCC 8th edition

KW - Lymph nodes

KW - Mouth neoplasms

KW - Squamous cell carcinoma of the head and neck

KW - Survival

UR - https://www.scopus.com/pages/publications/85182011411

U2 - 10.1016/j.suronc.2024.102033

DO - 10.1016/j.suronc.2024.102033

M3 - Article

C2 - 38211447

AN - SCOPUS:85182011411

SN - 0960-7404

VL - 52

SP - 1

EP - 7

JO - Surgical Oncology

JF - Surgical Oncology

M1 - 102033

ER -

Improving accuracy in nodal staging of oral cancer: Proposal of a new system

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Keywords

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