pN status predicts outcomes in surgically treated pT1–pT2 patients of various disease stages with squamous cell carcinoma of the head and neck: a 17-year retrospective single center cohort study

Qian, Xu; Sinikovic, Branko; Schreiber, Frank; Ochsenreither, Sebastian; Klinghammer, Konrad; Wollenberg, Barbara; Kaufmann, Andreas M.; Albers, Andreas

doi:10.1007/s00405-018-5108-z

Cited by 3 publications

(1 citation statement)

References 37 publications

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“…The pT and pN categories have been demonstrated to be independent factors for OS or PFS in both HPV-positive and HPV-negative OPSCC patients 7, 17. We also found pN status as the most important prognostic factor for a substantial proportion of patients with pT1 - pT2 HNSCC in our recent 17-year retrospective single center cohort study 18. These observations underscore the possible impact of traditional TNM classification on HNSCC outcome.…”

Section: Discussionsupporting

confidence: 71%

Prognostic Score Predicts Survival in HPV-Negative Head and Neck Squamous Cell Cancer Patients

Qian¹,

Nguyen²,

Dong³

et al. 2019

Int. J. Biol. Sci.

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Although patients having head and neck squamous cell carcinoma (HNSCC) have high mortality, standardized prognostic tools are unavailable. As such, having a validated simple prognostic scoring system to help predict mortality in these high-risk patients is urgently needed. The current study aimed to develop and internally validate a prognostic scoring system for overall mortality in human papillomavirus (HPV)-independent HNSCC patients. Data on 400 consecutive patients from the Cancer Genome Atlas database with a known HPV-RNA negative status were analyzed. A prognostic model to predict patient overall mortality was developed using the logistic regression beta coefficients and a simple risk score was created. The model was internally validated using bootstrap validation with 2000 replications. Five covariates (age, pT, pN, perineural invasion, and EAp53 score) were used in the development of the mortality risk score in the final model. Three risk groups were stratified based on the prognostic scores: low-risk (<96 points), medium-risk (96-121 points), and high-risk (≥122 points) with a survival of 76%, 62% and 35%, respectively. The proposed model presented good discrimination in both the development (AUC = 0.76; 95% CI 0.70, 0.81) and bootstrap validation (AUC = 0.76; 95% CI 0.70, 0.81) with a non-significant Hosmer-Lemeshow chi-square of 6.17 (p = 0.63). The proposed prognostic scoring system is easy to use to predict patient overall mortality and could also help in the appropriate allocation of medical resources while managing HNSCC patients. External validation (including re-calibration if needed) should be conducted to test the model's generalizability in different populations.

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Section: Discussionsupporting

confidence: 71%

Prognostic Score Predicts Survival in HPV-Negative Head and Neck Squamous Cell Cancer Patients

Qian¹,

Nguyen²,

Dong³

et al. 2019

Int. J. Biol. Sci.

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CT-Based Radiomics Signature for the Preoperative Discrimination Between Head and Neck Squamous Cell Carcinoma Grades

Wang

et al. 2019

Front. Oncol.

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Background: Radiomics has been widely used to non-invasively mine quantitative information from medical images and could potentially predict tumor phenotypes. Pathologic grade is considered a predictive prognostic factor for head and neck squamous cell carcinoma (HNSCC) patients. A preoperative histological assessment can be important in the clinical management of patients. We applied radiomics analysis to devise non-invasive biomarkers and accurately differentiate between well-differentiated (WD) and moderately differentiated (MD) and poorly differentiated (PD) HNSCC. Methods: This study involved 206 consecutive HNSCC patients (training cohort: n = 137; testing cohort: n = 69). In total, we extracted 670 radiomics features from contrast-enhanced computed tomography (CT) images. Radiomics signatures were constructed with a kernel principal component analysis (KPCA), random forest classifier and a variance-threshold (VT) selection. The associations between the radiomics signatures and HNSCC histological grades were investigated. A clinical model and combined model were also constructed. Areas under the receiver operating characteristic curves (AUCs) were applied to evaluate the performances of the three models. Results: In total, 670 features were selected by the KPCA and random forest methods from the CT images. The radiomics signatures had a good performance in discriminating between the two cohorts of HNSCC grades, with an AUC of 0.96 and an accuracy of 0.92. The specificity, accuracy, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of the abovementioned method with a VT selection for determining HNSCC grades were 0.83, 0.92, 0.96, 0.94, and 0.91, respectively; without VT, the corresponding results were 0.70, 0.83, 0.88, 0.80, and 0.84. The differences in accuracy, sensitivity and NPV were significant between these approaches ( p < 0.05). The AUCs with VT and without VT were 0.96 and 0.89, respectively ( p < 0.05). Compared to the combined model and the radiomics signatures, The clinical model had a worse performance, and the differences were significant ( p < 0.05). The combined model had the best performance, but the difference between the combined model and the radiomics signature weren't significant ( p > 0.05). Conclusions: The CT-based radiomics signature could discriminate between WD and MD and PD HNSCC and might serve as a biomarker for preoperative grading.

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Adjuvant Radiotherapy Significantly Increases Neck Control and Survival in Early Oral Cancer Patients with Solitary Nodal Involvement: A National Cancer Registry Database Analysis

Tsai

Kuo

et al. 2021

Cancers

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We assessed the role of adjuvant radiotherapy on neck control and survival in patients with early oral cancer with solitary nodal involvement. We identified pT1-2N1 oral cancer patients with or without adjuvant radiotherapy from the 2007–2015 Taiwan Cancer Registry database. The effect of adjuvant radiotherapy on 5-year neck control, overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan–Meier method, log-rank tests, and Cox regression analysis. Of 701 patients identified, 505 (72.0%) received adjuvant radiotherapy and 196 (28.0%) had surgery alone. Patients receiving adjuvant radiotherapy were more likely to be aged <65 years, pT2 stage, poorly graded and without comorbid conditions (all, p < 0.05). The 5-year OS and DFS differed significantly by receipt of adjuvant radiotherapy. Multivariable analysis showed adjuvant radiotherapy significantly associated with better 5-year OS (adjusted hazard ratio (aHR), 0.72; 95% confidence interval (CI), 0.54–0.97; p = 0.0288) and DFS (aHR, 0.64; 95% CI, 0.48–0.84; p = 0.0016). Stratified analysis indicated the greatest survival advantage for both 5-year OS and DFS in those with pT2 classification (p = 0.0097; 0.0009), and non-tongue disease (p = 0.0195; 0.0158). Moreover, adjuvant radiotherapy significantly protected against neck recurrence (aHR, 0.30; 95% CI, 0.18–0.51; p < 0.0001). Thus, adjuvant radiotherapy is associated with improved neck control and survival in these early oral cancer patients.

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pN status predicts outcomes in surgically treated pT1–pT2 patients of various disease stages with squamous cell carcinoma of the head and neck: a 17-year retrospective single center cohort study

Abstract: The pN status is the most important prognostic factor for pT1 to pT2 SCCHN. Adjuvant CRT was associated with significantly better survival outcomes in patients with pN1 and pN2-3 or more advanced stage, while adjuvant RT showed significantly better outcomes in patients with pN0.

Cited by 3 publications

References 37 publications

Prognostic Score Predicts Survival in HPV-Negative Head and Neck Squamous Cell Cancer Patients

Prognostic Score Predicts Survival in HPV-Negative Head and Neck Squamous Cell Cancer Patients

CT-Based Radiomics Signature for the Preoperative Discrimination Between Head and Neck Squamous Cell Carcinoma Grades

Adjuvant Radiotherapy Significantly Increases Neck Control and Survival in Early Oral Cancer Patients with Solitary Nodal Involvement: A National Cancer Registry Database Analysis

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