Risk Stratification in Oral Cancer: A Novel Approach

Tu, Irene Wen-Hui; Shannon, Nicholas B.; Thankappan, Krishnakumar; Balasubramanian, Deepak; Pillai, Vijay; Shetty, Vivek; Rangappa, Vidyabhushan; Chandrasekhar, Naveen Hedne; Kekatpure, Vikram D.; Kuriakose, Moni Abraham; Mitra, Arun; Arun, Pattatheyil; Jain, Prateek; Iyer, Subramania; Subramaniam, Narayana; Iyer, N. Gopalakrishna

doi:10.3389/fonc.2022.836803

Cited by 9 publications

(8 citation statements)

References 29 publications

(49 reference statements)

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“…The pathological type of all the patients in our study was squamous cell carcinoma. Recently, some researchers found that the PNI index and serum AGR level are significantly related to the OS of patients with esophageal cancer [ 34 , 35 ], oral cancer [ 36 , 37 ], and laryngeal cancer [ 38 , 39 ]. The researchers conducted a multivariate analysis of the PNI index and serum AGR level with the patients’ comorbidities, age, and other factors and found that both the PNI and the AGR were independent predictors of postoperative OS, which is consistent with our research conclusions.…”

Section: Discussionmentioning

confidence: 99%

The Predictive Significance of Prognostic Nutritional Index and Serum Albumin/Globulin Ratio on the Overall Survival of Penile Cancer Patients Undergoing Penectomy

Song

Gao

et al. 2022

Current Oncology

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Objective: To assess the value of using the prognostic nutritional index (PNI) and serum albumin/globulin ratio (AGR) in predicting the overall survival (OS) of patients with penile cancer (PC) undergoing penectomy. Materials and methods: A retrospective analysis of 123 patients who were admitted to our hospital due to PC from April 2010 to September 2021 and who underwent penectomy were included in the study. The optimal cut-off value of the PNI and AGR was determined by receiver operating characteristic curve analysis. Kaplan–Meier analysis and the Cox proportional hazard model were used to evaluate the correlation between the PNI, AGR, and OS in patients with PC. Results: A total of 16 of the 123 patients died during the follow-up period, and the median follow-up time was 58.0 months. The best cut-off values of the PNI and AGR were set to 49.03 (95% confidence interval 0.705–0.888, Youden index = 0.517, sensitivity = 57.9%, specificity = 93.7%, p < 0.001) and 1.28 (95% confidence interval 0.610–0.860, Youden index = 0.404, sensitivity = 84.1%, specificity = 56.2%, p = 0.003). The Kaplan–Meier analysis showed that the OS of the patients in the high PNI group and the high AGR group was significantly higher than that of the patients in the low PNI group and the low AGR group (p < 0.001). The univariable analysis showed that the aCCI, the clinical N stage, the pathological stage, and the PNI, AGR, SII, and PLR are all predictors of OS in patients with PC (p < 0.05). The multivariable analysis showed that the PNI (risk rate [HR] = 0.091; 95% CI: 0.010–0.853; p = 0.036) and the AGR (risk rate [HR] = 0.171; 95% CI: 0.043–0.680; p = 0.012) are independent prognostic factors for predicting OS in patients with PC undergoing penectomy. Conclusions: Both the PNI score and the serum AGR are independent prognostic factors for predicting OS in patients with PC undergoing penectomy.

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Section: Discussionmentioning

confidence: 99%

The Predictive Significance of Prognostic Nutritional Index and Serum Albumin/Globulin Ratio on the Overall Survival of Penile Cancer Patients Undergoing Penectomy

Song

Gao

et al. 2022

Current Oncology

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“…We further found that high-risk features may be additive, with 2 high risk features imparting worse prognosis than 1 high-risk feature. Previous studies in patients with OP and OC similarly showed that composite risk scores that incorporate multiple pathological features can improve prognostic risk stratification.…”

Section: Discussionmentioning

confidence: 98%

Association of Surgical Margin Distance With Survival in Patients With Resected Head and Neck Squamous Cell Carcinoma

Sunkara

Graff

Cramer

2023

JAMA Otolaryngol Head Neck Surg

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ImportanceClear surgical margins reduce the risk of local recurrence, improve survival, and determine decision-making with regard to adjuvant treatment of squamous cell carcinoma of the head and neck (SCCHN). However, the definitions of clear, close, or positive surgical margins vary in both the literature and in practice.ObjectiveTo examine whether the association between surgical margin distance and survival varies by primary tumor site.Design, Setting, and ParticipantsThis was a secondary analysis of a multi-institutional, multinational randomized clinical trial. The trial enrolled patients from January 22, 2007, to March 29, 2013, with stage II to IVA resected SCCHN with extranodal extension (ENE) or positive margins (&lt;5 mm from invasive tumor to the resected margin). The current analysis included those patients with known ENE and margin status and was conducted from April 29, 2022, to December 19, 2022.InterventionsPatients received adjuvant chemoradiotherapy plus either placebo or lapatinib.Main Outcomes and MeasuresOverall survival (OS) was calculated to examine association with surgical margin distance, primary site, and survival, with stratification by ENE status.ResultsAmong 688 patients enrolled in the trial, 630 patients with known ENE and margin status were included. Exact patient ages were not made available; 523 (83%) patients were male, and 415 (66%) patients were White. Patients with 1 high-risk feature (positive margins or ENE) had significantly better OS vs 2 high-risk features (hazard ratio [HR], 0.65; 95% CI, 0.49-0.87), although most other results were not statistically significant. For example, in the cohort with ENE-negative disease, multivariable adjusted analysis showed nonsignificant improvements with shorter surgical margin distance (1- to 5-mm margins), and no association with OS was found in the cohort with ENE-positive status (either &gt;5 mm margins or 1-5 mm margins). The association between survival and margin distance varied based on primary site, human papillomavirus (HPV) status, and ENE status. For example, HPV-positive status was associated with a significant and clinically meaningful increase in survival (adjusted HR, 0.33; 95% CI, 0.11-0.97). The improvement was greatest, although not significantly so, in patients with ENE- and HPV-negative oropharynx (OP), hypopharynx (HP), and larynx cancer (HR, 0.57; 95% CI, 0.30-1.10). No survival benefit was seen in ENE-negative oral cavity cancer (HR, 0.89; 95% CI, 0.45-1.77), nor was an association observed between margins and OS in HPV-positive OP cancer.Conclusions and RelevanceIn this secondary analysis of a randomized clinical trial, the presence of high-risk features (extranodal extension, positive margins, or both) was associated with worse survival; longer survival was observed with greater surgical margin distance among patients with oral cavity tumors and human papillomavirus–negative tumors of the OP, larynx, or HP. No other significant differences were found. These findings support variable interpretation of surgical margin distance based on the primary site and HPV status.Trial RegistrationClinicalTrials.gov Identifier: NCT00424255

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“…However, there is no universal definition of high-risk characteristics for OSCC, and in many situations, the clinical staging is not able of differentiating tumors with more aggressive behavior, that would benefit from specific therapeutic approaches. [5][6][7] Some histopathological features, besides depth of invasion and extranodal extension, have been associated with poor prognosis and in those cases, adjuvant treatment is frequently recommended. 8,9 Among those features are the infiltration of the neural structures.…”

Section: Introductionmentioning

confidence: 99%

“…In general, a meticulous evaluation of the clinical, radiographic and pathological features, such as the depth of invasion and extranodal extension, 4 is performed to properly stage the patients with OSCC in order to select the optimal therapeutic protocol. However, there is no universal definition of high‐risk characteristics for OSCC, and in many situations, the clinical staging is not able of differentiating tumors with more aggressive behavior, that would benefit from specific therapeutic approaches 5–7 . Some histopathological features, besides depth of invasion and extranodal extension, have been associated with poor prognosis and in those cases, adjuvant treatment is frequently recommended 8,9 .…”

Section: Introductionmentioning

confidence: 99%

Prognostic significance of the neural invasion in oral squamous cell carcinoma

Dólens

Morais

Paranaíba

et al. 2023

J Oral Pathology Medicine

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Background Although nerve involvement can predict recurrence and prognosis in oral squamous cell carcinomas, there still have controversies and limitations regarding the standardization for its detection. In this study, we explore the impact of neural invasion in oral squamous cell carcinomas prognosis, comparing intraneural invasion (tumor cells inside nerve structure) and perineural invasion (cells involving the nerve, but not invading its sheath). Methods Surgical slides stained with hematoxylin and eosin from 235 patients with oral squamous cell carcinomas were carefully verified for the presence of intraneural invasion and perineural invasion. The location in the tumor (intratumoral vs. peritumoral) and number of foci (unifocal or multifocal) were also explored. Survival analyses for cancer‐specific survival and disease‐free survival were performed with Cox proportional model. Results Neural invasion was identified in 74 cases, 64.9% displayed intraneural invasion and 35.1% displayed perineural invasion. Univariate analysis revealed a significantly poorer cancer‐specific survival, but not disease‐free survival, in patients with intraneural invasion, in contrast to cases with perineural invasion that did not achieve significant association with both cancer‐specific survival and disease‐free survival. Further analyses revealed that the location in the tumor and number of foci had little impact on discriminatory ability of intraneural invasion. Multivariate analysis confirmed that intraneural invasion is significantly and independently associated with poor cancer‐specific survival (hazard ratio: 2.50, 95% CI: 1.31–3.79, p = 0.003). Conclusion This study provides evidence that intraneural invasion, but not perineural invasion, is a relevant predictor of survival in patients with oral squamous cell carcinomas, suggesting that its association with other clinical and pathological prognostic factors should be consider in determining the optimal treatment protocol and prognosis of these patients.

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Risk Stratification in Oral Cancer: A Novel Approach

Cited by 9 publications

References 29 publications

The Predictive Significance of Prognostic Nutritional Index and Serum Albumin/Globulin Ratio on the Overall Survival of Penile Cancer Patients Undergoing Penectomy

The Predictive Significance of Prognostic Nutritional Index and Serum Albumin/Globulin Ratio on the Overall Survival of Penile Cancer Patients Undergoing Penectomy

Association of Surgical Margin Distance With Survival in Patients With Resected Head and Neck Squamous Cell Carcinoma

Prognostic significance of the neural invasion in oral squamous cell carcinoma

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