Evaluation of Staging Systems for Cancer of the Nasal Vestibule

Abstract

Squamous cell carcinoma of the nasal vestibule is reported to account for less than one percent of all head and neck malignancies. It lacks a designated WHO ICD-O topography code, and multiple systems are available for the staging of this disease, which results in unwanted variability and the subsequent poor reliability of data. The aim of this study was to evaluate the currently available staging systems for cancer of the nasal vestibule, including the recently introduced classification by Bussu et al., which built on Wang’s original concept but with clearer anatomical cutoffs. Different staging systems for cancer of the nasal vestibule (UICC nasal cavity, UICC skin cancer of the head and neck, Wang and Bussu et al.) were evaluated via a retrospective analysis of 148 patients. The staging system, per Bussu et al., had the most balanced allocation of patients among the stages. When using the Wang classification as a reference, stage migration occurred less frequently with the Bussu classification. The widespread adoption of a single staging system, as well as the introduction of a designated topography code for cancer of the nasal vestibule, could lead to more uniformity in data reporting and improve an understanding of the incidence and disease outcome. The newly proposed carcinoma of the nasal vestibule classification by Bussu et al. has the potential to improve the staging and allocation among stages. Further analysis of survival data is needed to assess which classification system is best suited for nasal vestibule carcinoma.

Validation of the “Rome” Classification for Squamous Cell Carcinoma of the Nasal Vestibule

“…for non-melanoma skin cancer of the head and neck (which is by definition inappropriate according to WHO, as the nasal vestibule is part of the nasal cavity) and the Wang classification [ 27 , 28 ]. Their individual advantages and disadvantages have already been discussed at length [ 31 ]. The Rome classification was proposed with the aim of being easier to use in clinical practice through focusing on anatomical landmarks and by allowing the integration of high-resolution imaging techniques.…”

“…Patients diagnosed with other histological subtypes (e.g., basal cell carcinoma, Merkel cell carcinoma, melanoma) were excluded. Part of this cohort has been described in a previous publication [ 31 ]. Each patient underwent comprehensive clinical assessment by a head and neck surgeon and radiation oncologist.…”

“…These all have their perks and shortcomings, and no consensus has been reached as to which system performs best, resulting in inconsistent registration and unnecessary heterogeneity of data [ 17 , 19 , 29 , 30 ]. Major downsides of the available staging systems are their insufficient practical applicability and the lack of integration of modern high-resolution imaging [ 31 ]. The new classification by Bussu et al has recently been introduced in an attempt to replace the aforementioned options by focusing on clinical usability, the site’s unique anatomy, and the typical patterns of disease spread [ 32 ].…”

“…The new classification by Bussu et al has recently been introduced in an attempt to replace the aforementioned options by focusing on clinical usability, the site’s unique anatomy, and the typical patterns of disease spread [ 32 ]. A universally adopted, properly designed staging system can help create uniformity in staging, registration, and, eventually, treatment [ 31 ]. Following the prior in-depth technical evaluation of the four existing staging systems for SCCNV, this study assesses the use of the novel Rome classification and its association with various survival outcomes.…”

Interventional Radiotherapy (Brachytherapy) for Nasal Vestibule: Novel Strategies to Prevent Side Effects

“…Moreover, the specific patterns of spread of NV cancers make the UICC/AJCC T classification criteria, in common with ethmoid and nasal cavity proper, inadequate for prognostic stratification, Wang's classification specifically designed for nose vestibule, and dating back to 1976, has been demonstrated to predict survival better [4]. Wang's criteria have been re-used for the novel Bussu T classification system, which has been, recently, preliminarily evaluated in a large multicentric series with very promising results [5].…”