A comparison of published head and neck stage groupings in carcinomas of the oral cavity

Groome, Patti A.; Schulze, Karleen; Boysen, Morten; Hall, Stephen F.; Mackillop, William J.

doi:10.1002/hed.1087

Cited by 97 publications

(111 citation statements)

References 19 publications

(31 reference statements)

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“…A good staging classification system should meet the following criteria (35): (a) survival rates should differ among the groups (hazard discrimination); (b) the subsets defined by T, N, and M that make up a given group should have similar survival rates (hazard consistency); (c) the patient distribution across the groups should be balanced; and (d) the cure prediction should be high (outcome prediction). Based on solid data with full statistical justification, and all analyses being duly adjusted for related variables to minimize potential biases, the proposed N staging system was proved to be powerfully predictive.…”

Section: Discussionmentioning

confidence: 99%

The N Staging System in Nasopharyngeal Carcinoma with Radiation Therapy Oncology Group Guidelines for Lymph Node Levels Based on Magnetic Resonance Imaging

Mao¹,

Liang²,

Liu³

et al. 2008

Clinical Cancer Research

136

130

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Purpose:To evaluate the prognostic value of variables including nodal size, level, laterality, extranodal neoplastic spread (ENS), and necrosis in patients with nasopharyngeal carcinoma (NPC) and further explore the feasibility of an N-staging system using Radiation Therapy Oncology Group (RTOG) guidelines for lymph node levels based on magnetic resonance imaging (MRI). Experimental Design: The MRI scans of 924 patients with histologically diagnosed nondisseminated NPC were reviewed retrospectively. The distribution of the tumors was mapped using RTOG guidelines and laterality. The multiplicity of each tumor was calculated, as well as the size and status of ENS and the necrosis of individual nodes. Results: Nodal level, cervical lymph node laterality, and ENS were independent prognostic factors for disease failure and distant failure in multivariate analyses. There was no significant difference in the hazard ratios (HR) for distant failure between level II and retropharyngeal, level Ib, levelV, or level III involvement, whereas patients with level IVand supraclavicular fossa involvement had a significant increase in HRs. The subsets that made up a given N stage group had similar HRs for distant failure. Both the HRs for disease failure and distant failure by the proposed N staging system between one stage and the next were statistically significant (P < 0.05). The survival curves of disease-free survival and distant metastasis-free survival for all subclassifications of N stage showed significant difference from the adjacent stage (P < 0.05). The overall distribution pattern of the proposed N staging was more equitable than that of the 6th American Joint Committee on Cancer N staging. Conclusions: Nodal variables including level, cervical lymph node laterality, and ENS are independent prognostic factors for NPC. The proposed N staging system of NPC using RTOG guidelines based on MRI is highly predictive and may provide a more objective method for staging NPCs.

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Section: Discussionmentioning

confidence: 99%

The N Staging System in Nasopharyngeal Carcinoma with Radiation Therapy Oncology Group Guidelines for Lymph Node Levels Based on Magnetic Resonance Imaging

Mao¹,

Liang²,

Liu³

et al. 2008

Clinical Cancer Research

136

130

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“…Second, the survival rates should differ among the groups (hazard discrimination). Third, the distribution of patients among the groups should be balanced (29).…”

Section: Discussionmentioning

confidence: 99%

“…Because RLN criteria in the published staging systems are ambiguous, RLN involvement had been classified as T 2 (29) or N 1 (13) in different studies. According to the general principle used by the AJCC staging system, RLN should be classified as N 1 if unilateral and N 2 if bilateral.…”

Section: Discussionmentioning

confidence: 99%

Retropharyngeal Lymph Node Metastasis in Nasopharyngeal Carcinoma: Prognostic Value and Staging Categories

Ma¹,

Liu²,

Tang³

et al. 2007

Clinical Cancer Research

106

102

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Purpose: To investigate the incidence, prognostic value, and staging categories of retropharyngeal lymph node (RLN) metastasis in nasopharyngeal carcinoma (NPC). Experimental Design: We did a retrospective review of the data from 749 biopsy-proved nonmetastatic NPC patients. All patients had undergone contrast-enhanced computed tomography and had radiotherapy as their primary treatment. Results:The incidence of RLN metastasis was 51.5%. After adjusting for tumor (T) and node (N) classifications, a borderline significant difference of distant metastasis-free survival (DMFS) rates was observed between patients with or without RLN metastasis. In N 0 disease, the presence of RLN metastasis was a significant independent predictor for overall survival (OS), loco-regional relapse-free survival, and DMFS in multivariate Cox modeling analysis. No significant difference was observed in all end points between patients with unilateral and bilateral RLN metastasis. The hazard ratios of death and distant failure for N 0 with RLN metastasis were similar to N 1 . The survival curve of OS and DMFS for N 0 disease with RLN metastasis had approximated that of N 1 disease. The survival curve of OS for T 1 disease with RLN metastasis was approximately the same as T 2 disease. However, the survival curve of DMFS for T 1 disease with RLN metastasis was approximately the same as inT 3 disease. Conclusions: RLN metastasis has a tendency to affect the DMFS rates of patients with NPC. Retropharyngeal node involvement has a negative effect on the prognosis of N 0 disease. RLN metastasis should be classified as N 1 .

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“…Although the simplicity of the current system promotes clinical utility, it is widely acknowledged that the prognostic performance is suboptimal in some patients with head and neck cancer. [2][3][4] This may reflect the substantial changes in management of oral SCC in the last 4 decades, based on advances in cross-sectional imaging, the introduction of positron emission tomography, the widespread use of microvascular free flap reconstruction, and significant progress in adjuvant therapy protocols. In conjunction with this evolution in management paradigms, a vast body of literature has accumulated detailing important prognostic factors in oral cancer.…”

mentioning

confidence: 98%

Primary Tumor Staging for Oral Cancer and a Proposed Modification Incorporating Depth of Invasion

Ebrahimi

Gil

Amit

et al. 2014

JAMA Otolaryngol Head Neck Surg

264

165

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A comparison of published head and neck stage groupings in carcinomas of the oral cavity

Cited by 97 publications

References 19 publications

The N Staging System in Nasopharyngeal Carcinoma with Radiation Therapy Oncology Group Guidelines for Lymph Node Levels Based on Magnetic Resonance Imaging

The N Staging System in Nasopharyngeal Carcinoma with Radiation Therapy Oncology Group Guidelines for Lymph Node Levels Based on Magnetic Resonance Imaging

Retropharyngeal Lymph Node Metastasis in Nasopharyngeal Carcinoma: Prognostic Value and Staging Categories

Primary Tumor Staging for Oral Cancer and a Proposed Modification Incorporating Depth of Invasion

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