Number of positive nodes – Current relevance in determining prognosis of oral cavity cancer after the recent AJCC staging update

Rajappa, Suhas Kodasoge; Maheshwari, Udip; Jaipuria, Jiten; Singh, Anupam; Goyal, Sumit; Batra, Ullas; Kumar, Rajeev; Dewan, Ajay Kumar

doi:10.1016/j.oraloncology.2019.01.001

Cited by 17 publications

(13 citation statements)

References 16 publications

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“…Therefore, 20 studies were eligible as they evaluated the prognostic performance of AJCC 8 in OSCC (Figure 1). Of these, seven studies were from Asia, [18][19][20][21][22][23][24] four were from Australia, 12,[25][26][27] four from Europe, [28][29][30][31] four from North America, 14,[32][33][34] and one from South America. 35 In addition, a Brazilian cohort was analyzed in one of the published studies combined with a Finnish cohort.…”

Section: Search Resultsmentioning

confidence: 99%

“…Therefore, some of the studies that assessed the performance of AJCC 8 showed that the number of positive metastatic nodes can be a good modifier for the N classification. 23,24,32 Findings of these studies should be considered for future research as they might be useful for further improvement of TNM staging.…”

Section: Discussionmentioning

confidence: 97%

“…Interestingly, Ebrahimi et al 49 based on an international multicenter cohort have reported on promising significance of the number of metastatic lymph nodes in OSCC. Therefore, some of the studies that assessed the performance of AJCC 8 showed that the number of positive metastatic nodes can be a good modifier for the N classification 23,24,32 . Findings of these studies should be considered for future research as they might be useful for further improvement of TNM staging.…”

Section: Discussionmentioning

confidence: 99%

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Risk stratification in oral squamous cell carcinoma using staging of the eighth American Joint Committee on Cancer: Systematic review and meta‐analysis

et al. 2020

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The eighth edition of the American Joint Committee on Cancer (AJCC8) staging manual has major changes in oral squamous cell carcinoma (OSCC). We searched PubMed, OvidMedline, Scopus, and Web of Science for studies that examined the performance of AJCC8 in OSCC. A total of 40 808 patients were included in the studies of our meta‐analysis. A hazard ratio (HR) of 1.87 (95%CI 1.78‐1.96) was seen for stage II, 2.65 (95%CI 2.51‐2.80) for stage III, 3.46 (95%CI 3.31‐3.61) for stage IVa, and 7.09 (95%CI 4.85‐10.36) for stage IVb. A similar gradual increase in risk was noted for the N classification. For the T classification, however, there was a less clear variation in risk between T3 and T4. AJCC8 provides a good risk stratification for OSCC. Future research should examine the proposals introduced in the published studies to further improve the performance of AJCC8.

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Section: Search Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Risk stratification in oral squamous cell carcinoma using staging of the eighth American Joint Committee on Cancer: Systematic review and meta‐analysis

et al. 2020

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“…Nevertheless, the number of histopathologically positive lymph nodes among the total amount of dissected nodes was already proposed as a predictive marker for outcome in head and neck cancer in 1994 [25]. Recently, numerous authors characterized the number of positive lymph nodes as an independent prognostic factor for OSCC [13,26]. Even though the occurrence of positive lymph nodes is taken into account in the current TNM classification for OSCC [9], no further differentiation is made if more than one lymph node is affected.…”

Section: Discussionmentioning

confidence: 99%

Lymph node ratio as a predictor for outcome in oral squamous cell carcinoma: a multicenter population-based cohort study

et al. 2020

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Objectives Recently, multiple studies addressed the importance of lymph node ratio (LNR) in specifying patients' risk of disease recurrence in various malignancies. The present study examines the prognostic significance of LNR in predicting outcome of oral squamous cell carcinoma (OSCC) patients after surgical treatment with curative intent. Methods Here, we describe a retrospective population-based cohort with 717 patients previously diagnosed with OSCC. Histopathologically verified lymph node metastasis was diagnosed in 290 patients. Among these patients, we evaluated the impact of LNR on overall survival (OAS) and recurrence-free survival (RFS) in uni-as well as multivariate analysis. Results A median cutoff (0.055) in LNR was found to significantly predict outcome in OSCC patients. Five-year OAS was 54.1% in patients with a low LNR, whereas a high LNR was associated with a 5-year OAS of 33.3% (p < 0.001). Similar results were detected for RFS with a 5-year survival rate of 49.8% (LNR low) and 30.3% (LNR high) (p = 0.002). Results were confirmed in multivariate Cox regression which substantiated the importance of LNR in predicting survival in OSCC patients. Conclusions LNR was shown to be an independent prognostic factor for outcome of OSCC in a population-based cohort in unias well as multivariate analysis. Hereby, a LNR ≥ 0.055 predicted a shorter OAS and RFS in our cohort. Clinical relevance Besides established histopathological factors, LNR can be used as a reliable predictor of outcome in OSCC and might therefore be further applied in evaluating adjuvant treatment after resection in curative intention.

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“…However, a number of researchers have noted that this classification fails to detect the survival difference between N1 and N2a disease (7), and also between N2b and N2c disease (8). Thus, a proposed nodal system based on the number of positive lymph nodes is suggested, and it is verified to be superior to the 8th AJCC classification (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Survival Significance of Number of Positive Lymph Nodes in Oral Squamous Cell Carcinoma Stratified by p16

Fang

Yang

et al. 2021

Front. Oncol.

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Objectives: To analyze the significance of the number of positive lymph nodes in oral squamous cell carcinoma (SCC) stratified by p16.Methods: A total of 674 patients were retrospectively enrolled and divided into 4 groups based on their number of positive lymph nodes (0 vs. 1–2 vs. 3–4 vs. ≥5). The Kaplan-Meier method was used to calculate the disease-free survival (DFS) and disease-specific survival (DSS) rates. Cox model was used to evaluate the independent risk factor.Results: p16 showed positivity in 85 patients with a rate of 12.6%. In patients with p16 negativity, the 5-year DFS rates were 52%, 39%, and 21% in patients with 0, 1–2, and 3–4 positive lymph nodes, respectively, in patients with ≥5 positive lymph nodes, all patients developed recurrence within 2 years after operation, the difference was significant; the 5-year DSS rates were 60, 38, and 18% in patients with 0, 1–2, and 3–4 positive lymph nodes, respectively, in patients with ≥5 positive lymph nodes, all patients died within 4-years after operation. The difference was significant. In p16 positivity patients, the 3-year DFS rates were 41% and 17% in patients with 0–2 and ≥3 positive lymph nodes, respectively, the difference was significant; the 3-year DSS rates were 84 and 46% in patients with 0–2 and ≥3 positive lymph nodes, the difference was significant.Conclusions: The number of positive lymph nodes is significantly associated with the survival in oral SCC, its survival effect is not affected by p16 status.

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Number of positive nodes – Current relevance in determining prognosis of oral cavity cancer after the recent AJCC staging update

Cited by 17 publications

References 16 publications

Risk stratification in oral squamous cell carcinoma using staging of the eighth American Joint Committee on Cancer: Systematic review and meta‐analysis

Risk stratification in oral squamous cell carcinoma using staging of the eighth American Joint Committee on Cancer: Systematic review and meta‐analysis

Lymph node ratio as a predictor for outcome in oral squamous cell carcinoma: a multicenter population-based cohort study

Survival Significance of Number of Positive Lymph Nodes in Oral Squamous Cell Carcinoma Stratified by p16

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