Comparing prognostic utility between the 8th edition of <scp>TNM</scp> staging system and the lymph node ratio for oral squamous cell carcinoma

Beltramini, Giada Anna; Belloni, Laura M.; Fusco, Nicola; Sacconi, Andrea; Muti, Paola; Baj, A.; Bolzoni, Alessandro; Giannì, Aldo Bruno

doi:10.1002/hed.26769

Cited by 7 publications

(8 citation statements)

References 36 publications

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“…Although an association between LNY and outcomes among patients with pN-positive disease was not observed in this study, LNR was significantly associated with LRC and DFS. These associations in oral cavity cancers have previously been reported, and these findings further support LNR being a predictor for these outcomes . This quantitative measure of regional disease burden shows that there is potential to augment previous prognostic indicators, while being less susceptible to variance that could result from differing extensiveness of neck dissections.…”

Section: Discussionsupporting

confidence: 79%

Assessing Prognostic Value of Quantitative Neck Dissection Quality Measures in Patients With Clinically Node-Negative Oral Cavity Squamous Cell Carcinoma

Farrokhian

Holcomb

Dimon

et al. 2022

JAMA Otolaryngol Head Neck Surg

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ImportanceIn clinically localized (T1-2) oral cavity squamous cell carcinoma (OCSCC), regional lymph node metastasis is associated with a poor prognosis. Given the high propensity of subclinical nodal disease in these patients, upfront elective neck dissections (END) for patients with clinically node-negative disease are common and associated with better outcomes. Unfortunately, even with this risk-adverse treatment paradigm, disease recurrence still occurs, and our understanding of the factors that modulate this risk and alter survival have yet to be fully elucidated.ObjectiveTo investigate the prognostic value of lymph node yield (LNY), lymph node ratio (LNR), and weighted LNR (wLNR) in patients with clinically node-negative T1-2 OCSCC.Design, Setting, and ParticipantsIn this cohort study, data were collected retrospectively from 7 tertiary care academic medical centers. Overall, 523 patients with cT1-2N0 OCSCC who underwent elective neck dissections after primary surgical extirpation were identified.ExposuresLymph node yield was defined as the number of lymph nodes recovered from elective neck dissection. Lymph node ratio was defined as the ratio of positive nodes against total LNY. Weighted LNR incorporated information from both LNY and LNR into a single continuous metric.Main Outcomes and MeasuresLocoregional control (LRC) and disease-free survival (DFS) were both evaluated using nonparametric Kaplan-Meier estimators and semiparametric Cox regression.ResultsOn multivariable analysis, LNY less than or equal to 18 lymph nodes was found to be significantly associated with decreased LRC (aHR, 1.53; 95% CI, 1.04-2.24) and DFS (aHR, 1.46; 95% CI, 1.12-1.92) in patients with pN0 disease, but not those with pN-positive disease. Importantly, patients with pN0 disease with LNY less than or equal to 18 and those with pN1 diseasehad nearly identical 5-year LRC (69.7% vs 71.4%) and DFS (58.2% vs 55.7%). For patients with pN-positive disease, LNR greater than 0.06 was significantly associated with decreased LRC (aHR, 2.66; 95% CI, 1.28-5.55) and DFS (aHR, 1.65; 95% CI, 1.07-2.53). Overall, wLNR was a robust prognostic variable across all patients with cN0 disease, regardless of pathologic nodal status. Risk stratification via wLNR thresholds demonstrated greater optimism-corrected concordance compared with American Joint Committee on Cancer (AJCC) 8th edition nodal staging for both LRC (0.61 vs 0.57) and DFS (0.61 vs 0.58).Conclusions and RelevanceMovement toward more robust metrics that incorporate quantitative measures of neck dissection quality and regional disease burden, such as wLNR, could greatly augment prognostication in cT1-2N0 OCSCC by providing more reliable and accurate risk estimations.

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Section: Discussionsupporting

confidence: 79%

Assessing Prognostic Value of Quantitative Neck Dissection Quality Measures in Patients With Clinically Node-Negative Oral Cavity Squamous Cell Carcinoma

Farrokhian

Holcomb

Dimon

et al. 2022

JAMA Otolaryngol Head Neck Surg

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“…According to previous studies, the prognosis of OSCC is highly heterogeneous, with an overall 5-year survival rate of approximately 64%, and the median survival duration for patients with locoregionally recurrent or metastatic OSCC is 8~10 months (31,32). Oral malignancies progress through four stages; in the early stage (stages I and II), the 5-year survival rate is approximately 80%.…”

Section: Discussionmentioning

confidence: 99%

The Ratio of Preoperative Serum Biomarkers Predicts Prognosis in Patients With Oral Squamous Cell Carcinoma

et al. 2021

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BackgroundDynamic changes in circulating immune-inflammatory cells have been regarded as simple and convenient prognostic biomarkers in various cancers. However, studies on the prognostic values of their ratios in oral squamous cell carcinoma (OSCC) remain limited.Materials and MethodsA total of 493 OSCC patients were included in the present study. Here, we investigated the prognostic values of the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), neutrophil-to-white blood cell ratio (NWR), and lymphocyte-to-white blood cell ratio (LWR) in OSCC. The correlations of the NLR, LMR, NWR, and LWR with clinicopathological characteristics were statistically analyzed using the Chi-square test, Kaplan-Meier curves, and univariate and multivariate Cox regression models.ResultKaplan-Meier analyses revealed that OSCC patients with a high LMR and low NWR had prolonged overall survival (OS, P<0.001) and disease-free survival (DFS, P<0.001 and P=0.003, respectively), but there were no significant differences in metastasis-free survival (MFS, P=0.053 and P=0.052, respectively). In contrary, a high NLR and low LWR were associated with poor OS (P<0.001 and P=0.0016, respectively), DFS (P=0.0014 and 0.0012, respectively) and MFS (P=0.021 and 0.008, respectively). Additionally, Cox multivariate analyses showed that the LMR was an independent prognostic factor for both OS (P=0.007) and DFS (P=0.017), while the LWR was an independent prognostic factor for MFS (P=0.009).ConclusionPreoperative NLR, LMR, NWR, and LWR in the peripheral blood are significant prognostic factors for OSCC and might be helpful in predicting OSCC progression.

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“…Due to the optimal threshold of ELN of 22, we classified ELN as ELN1 (≤22) and ELN2 (>23) groups. Because of optimal thresholds of PLN being 1 and 11, PLN was divided into PLN1 (≤1), PLN2 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11), and PLN3 (≥12) groups. Due to the optimal threshold of LNR being 0.29 and 0.81, LNR was classified as LNR1 (0-0.29), LNR2 (0.30-0.81), and LNR3 (0.81-1) groups.…”

Section: Data Extraction From the Surveillance Epidemiology And End R...mentioning

confidence: 99%

A Nomogram Based on the Log Odds of Positive Lymph Nodes Predicts the Prognosis of Patients with Colon Neuroendocrine Tumors After Surgery: A Surveillance, Epidemiology, and End Results Population-Based Study

Xue

Zhang²,

et al. 2023

Technol Cancer Res Treat

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Purpose This work focused on determining the highly efficient nodal classification system from American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) classification (eighth edition), positive lymph node, log odds of positive lymph nodes (LODDS), lymph node ratio, examined lymph node, and establishing the new nomogram for predicting cancer-specific survival in colon neuroendocrine tumors (CNETs). Methods From the Surveillance, Epidemiology, and End Results database, 943 CNET cases undergoing radical operation were enrolled, and randomized as training ( n = 663) or validation set ( n = 280). For the above 5 lymph node classification systems, their prediction performances were compared with C-index, Akaike information criterion (AIC), and area under the receiver operating characteristic curve. Univariate together with multivariate regression was carried out for identifying independent risk factors. Afterward, this work established 1 nomogram and confirmed its accuracy based on C-index, calibration curves, together with the area under the curve value. Besides, it was compared with the AJCC TNM classification system with regard to model prediction performance. Results LODSS achieved the greatest area under the curve and C-index, whereas the smallest AIC. Upon multivariate regression, age, histologic grade, T stage, M stage, and LODDS independently predicted the risk of CNETs. For the validation set, the C-index of the nomogram was 0.794, and the area under the curves at 1, 3, and 5 years was 0.826, 0.857, and 0.870, separately. Additionally, as revealed by the C-index, AIC, decision curve analysis, as well as Kaplan–Meier analysis, our nomogram had superior performance to the AJCC TNM classification system. Conclusions For postoperative patients with CNETs, the LODDS might achieve the best prediction performance. Moreover, the LODDS-based nomograms might show superior survival prediction performance to the AJCC TNM classification system (eighth edition).

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Comparing prognostic utility between the 8th edition of TNM staging system and the lymph node ratio for oral squamous cell carcinoma

Cited by 7 publications

References 36 publications

Assessing Prognostic Value of Quantitative Neck Dissection Quality Measures in Patients With Clinically Node-Negative Oral Cavity Squamous Cell Carcinoma

Assessing Prognostic Value of Quantitative Neck Dissection Quality Measures in Patients With Clinically Node-Negative Oral Cavity Squamous Cell Carcinoma

The Ratio of Preoperative Serum Biomarkers Predicts Prognosis in Patients With Oral Squamous Cell Carcinoma

A Nomogram Based on the Log Odds of Positive Lymph Nodes Predicts the Prognosis of Patients with Colon Neuroendocrine Tumors After Surgery: A Surveillance, Epidemiology, and End Results Population-Based Study

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