A critical analysis of the 8th edition TNM staging for head and neck cutaneous squamous cell carcinoma with lymph node metastases and comparison to N1S3 stage and ITEM risk score: A multicenter study

Abstract

Background and Objectives: We performed a critical analysis of the 8th edition American Joint Committee on Cancer (AJCC) staging for head and neck cutaneous squamous cell carcinoma (HNcSCC) with nodal metastases and compared the performance to the N1S3 and ITEM systems. Methods: Multicenter study of 990 patients with metastatic HNcSCC treated with curative intent. The end points of interest were disease-specific (DSS) and overall survival (OS). Model fit was evaluated using Harrell's Concordance Index (C-index), proportion of variation explained (PVE), Akaike information criterion, and Bayesian information criterion. Results: N1S3 and ITEM demonstrated good distribution into risk categories in contrast to the AJCC system, which classified the majority (90.6%) of patients as N2-3 and Stage IV due to the high rate of extranodal extension. The N2c and N3a categories appeared redundant. There was considerable discordance between systems in risk allocation on an individual patient basis. N1S3 was the best performed (DSS: C-index 0.62, PVE 10.9%; OS: C-index 0.59, PVE 4.5%), albeit with relatively poor predictive value. Conclusions: The AJCC N category and tumor node metastasis stage have poor patient distribution and predictive performance in HNcSCC. The AJCC stage, N1S3, and ITEM score all provide limited prognostic information based on objective measures highlighting the need to develop a staging system specific to HNcSCC. K E Y W O R D S cancer staging, cutaneous squamous cell carcinoma, head and neck cancer, lymph node metastasis, prognosis How to cite this article: Ebrahimi A, Luk PP, Low H, et al. A critical analysis of the 8th edition TNM staging for head and neck cutaneous squamous cell carcinoma with lymph node metastases and comparison to N1S3 stage and ITEM risk score: A multicenter study.

Construction of a necroptosis‐related lncRNA signature to predict the prognosis and immune microenvironment of head and neck squamous cell carcinoma

“…Referring to previous studies, there is a lack of reliable prognostic biomarkers to predict the prognosis of patients with HNSCC, which is increasing worldwide with poor 5‐year survival rates. 4 , 5 , 23 Multiple studies have investigated the correlations between programmed cell death (e.g., pyroptosis)‐related genes and lncRNAs and HNSCC prognosis, assisting in determining clinical outcomes. 24 Necroptosis is reportedly involved in tumor progression and suppression and can be considered a novel therapeutic target for HNSCC patients.…”

Construction of an m6A‐related lncRNA pair prognostic signature and prediction of the immune landscape in head and neck squamous cell carcinoma

“…Because of tumor heterogeneity and complicated carcinogenic mechanisms involved in HNSCC, the most applied TNM staging system fails to suitably interpret the prognosis of patients. 34 , 35 Hence, the identification of efficient prognostic biomarkers for HNSCC is a critical necessity. Accumulating research evidence has demonstrated that m6A modification is closely associated with cancer pathogenesis.…”

Evolution of Head and Neck Cutaneous Squamous Cell Carcinoma Nodal Staging—An Australian Perspective

“…Ebrahimi et al compared the prognostic performance of the AJCC 8th edition against the N1S3 and ITEM systems in a multicentre cohort of 990 patients [ 26 ]. Model performance was measured using PVE, C-index, Akaike Information Criterion (AIC), and Bayesian Information Criterion (BIC).…”