Modified Tumor Classification With Inclusion of Tumor Characteristics Improves Discrimination and Prediction Accuracy in Oral and Hypopharyngeal Cancer Patients Who Underwent Surgery

Abstract

Several histopathological characteristics have a significant prognostic impact on recurrence and survival rates in head and neck squamous cell carcinoma (HNSCC). We conducted a retrospective study on patients with HNSCC to compare traditional pathological T (pT) classification to a new T classification system that incorporates these histopathological characteristics.Newly diagnosed patients with HNSCC (n = 349) post major surgery were identified from the cancer registry database between 2004 and 2013. The pT and new T classification systems were compared with respect to recurrence-free survival (RFS), disease-specific survival (DSS), and survival rates using the Cox proportional hazards model with adjustments. The discriminatory ability of these 2 classification systems was evaluated using the adjusted hazard ratio (HR) and Akaike information criterion (AIC) in a multivariate regression model. The prediction accuracy was assessed using Harrell's C-statistic.The new T classification, which incorporated tumor size, extent, and location with histopathological features had better discriminatory ability and monotonicity of gradients than did pT classification. The new T4 classification yielded a higher adjusted HR in RFS (HR, 4.11; 95% confidence interval [CI], 7.75–9.65) and in DSS (HR, 4.39; 95% CI, 1.6–12.03), and a lower AIC in recurrence (927 vs 969) and survival rates (791 vs 833).The new T classification system had better discriminatory ability in RFS and DSS compared with the routinely used American Joint Committee on Cancer (AJCC) pT classification system. Therefore, this new T classification system, which includes tumor size, location, extent, and histopathological features, could be used as an alternative to AJCC pT classification for patients with HNSCC.

The diagnostic role of diffusion-weighted magnetic resonance imaging in hypopharyngeal carcinoma

“…The inclusion criteria were as follows: i) Suspicious lesions in the hypopharynx on laryngostroboscopy; ii) 3.0-T MRI (including DWI, b=0 and 1,000 sec/mm 2 ) prior to treatment; iii) surgery, concurrent chemo-radiotherapy (CCR) and pathological confirmation of diagnoses (including frozen sections and routine pathological results); and iv) availability of complete clinical data. Exclusion criteria were as follows: i) Incomplete clinical data; ii) 3.0-T MR without DWI prior to treatment; iii) undetermined Tumor-Node-Metastasis (TNM) stage of hypopharyngeal carcinoma ( 11 ) or recurrent hypopharyngeal carcinoma requiring a second surgery.…”

“…All MRI examinations were performed using a 3.0-T MRI scanner (Philips Achieva ® 3.0T; Royal Philips Electronics, Amsterdam, Netherlands) with a 16-channel head and neck coil. Conventional MRI included an axial T1-weighted turbo spin echo (TSE) sequence with the following parameters ( 11 ): Slice thickness, 4 mm; 24 slices; intersection gap, 1 mm; repetition time/echo time (TR/TE), 450 ms/10 ms; matrix, 320×224; field of view (FOV), 240×180 mm; and an axial T2-weighted TSE sequence (slice thickness, 4 mm; 24 slices; intersection gap, 1 mm; TR/TE, 400 ms/10 ms; matrix, 320×224; FOV, 240×180 mm). The coronal T2-weighted TSE sequence included the following parameters: Slice thickness, 4 mm; 24 slices; intersection gap, 1 mm; TR/TE, 400 ms/10 ms; matrix 320×224; FOV, 240×220 mm; and two signals were acquired, covering the larynx.…”

“…All hypopharyngeal lesions were characterized based on the signal intensity in T1- and T2-weighted MRIs and enhancement characteristics. DW-MRI at a native b-value of 1,000 sec/mm 2 (b-1,000 images) and the corresponding ADC maps were matched to and evaluated with the morphological images as previously described ( 11 ). A hyperintense signal on the native b-1,000 image compared with the surrounding tissue with a corresponding low signal intensity in the matching ADC map was considered positive for a tumor.…”

“…However, to the best of our knowledge, few previous studies have investigated the role of DWI at a single site in the head and neck regions. To the best of our knowledge, our previous study was the first to successfully use DWI and 3.0-T MRI to differentiate preoperative laryngeal carcinomas from precursor lesions ( 11 ), and there have been no previous studies regarding the use of ADC values and single-shotecho-planar imaging sequence (EPI) of 3.0-T MRI alone in hypopharyngeal carcinoma.…”

Impact of HPV infection on oral squamous cell carcinoma

“…HPV infection is often detected with immunohistochemistry (IHC) of p16 INK4a . HPV associated oncoproteins as E7 are influencing the expression of p16 INK4a (Figures 1 and 2) [17–19]. Therefore p16 INK4a is used as an HPV-related surrogate marker in many study protocols because the procedure is well-established and time saving [20, 21].…”