Staging of head and neck cancers: Is it time to change the balance between the ideal and the practical?

Patel, Snehal G.; Lydiatt, William M.

doi:10.1002/jso.21021

Cited by 55 publications

(57 citation statements)

References 35 publications

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“…[9][10][11] We have previously reported on the use of a nomogram for postoperative management of patients with oral cancer, 12 and proposed the use of nomograms for staging of head and neck cancer. 3 With this study, we introduce the concept of using individualized risk prediction tools for estimating OS, cancer-specific mortality, and locoregional recurrence risk in individual patients undergoing surgery with or without radiation therapy for SCCOC. These initial preoperative nomograms are based on a combination of host factors, such as age, sex, and race, and tumor characteristics, such as anatomic subsite affected, clinical estimation of tumor size, and the presence of clinical and/or radiological nodal metastases.…”

Section: Discussionmentioning

confidence: 99%

“…20 Cancer-related outcomes are influenced by a number of factors, and clinicians commonly consider prognostic factors that are not included in the TNM system for decision-making in actual patient care. 3 The vast majority of these factors have not been incorporated into the staging system because they may not predict outcome "independently" in multivariate models of prognostication. However, it is very clear that outcomes of cancer treatment are influenced by multiple factors.…”

Section: Discussionmentioning

confidence: 99%

“…2 Furthermore, the outcome of interest used by the TNM staging system is overall survival (OS); however, other outcomes, such as disease-specific survival, local control, or regional control, may be more relevant to assess treatment results and different therapeutic options. 3 A statistical tool such as a nomogram has the ability to take into account numerous variables to predict an outcome of interest for an individual patient. 4 Nomograms have been widely tested in a variety of cancers, with more than 1000 publications available in the literature.…”

Section: Introductionmentioning

confidence: 99%

“…We have previously outlined a modular concept to use nomograms in the staging of head and neck cancer. 3 As an initial step toward achieving this goal, we report the development of a set of nomograms that can accurately predict an individual patient's OS, risk of cancer-related mortality, and risk of locoregional recurrence, using information available prior to surgical management, while maintaining the user friendliness of the TNM system.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Nomograms for preoperative prediction of prognosis in patients with oral cavity squamous cell carcinoma

Montero

Yu²,

Palmer

et al. 2013

Cancer

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114

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BACKGROUND: This study sought to develop prognostic tools that will accurately predict overall and cancer-related mortality and risk of recurrence in individual patients with oral cancer based on host and tumor characteristics. These tools would take into account numerous prognosticators beyond those covered by the traditional TNM (tumor-node-metastasis) staging system. METHODS: Demographic, host, and tumor characteristics of 1617 patients with cancer of the oral cavity, who were treated primarily with surgery at a single-institution tertiary care cancer center between 1985 and 2009, were reviewed from a preexisting database. Recurrent disease was recorded in 509 patients (456 locoregional and 116 distant); 328 patients died of cancer-related causes, and 542 died of other causes. The median follow-up was 42 months (range, 1-300 months). The following variables were analyzed as predictors of prognosis: age, sex, race, alcohol and tobacco use, oral cavity subsite, invasion of other structures, comorbidity, tumor size, and clinical nodal status. The stepdown method was used to select the statistically most influential predictors for inclusion in the final nomogram for each outcome of interest. RESULTS: The most influential predictors of both recurrence and cancer-specific mortality probability (CSMP) were tumor size, nodal status, subsite, and bone invasion. Nomograms were generated for prediction of overall survival (OS), CSMP, and locoregional recurrence-free probability (LRRFP). The nomograms were internally validated with an overfit-corrected predictive discrimination metric (concordance index) for OS of 67%, CSMP of 66%, and LRRFP of 60%. CONCLUSIONS: Nomograms have been developed that can reasonably estimate OS, CSMP, and LRRFP based on specific tumor and host characteristics in patients with oral cancer. Cancer 2014;120:214-21.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Nomograms for preoperative prediction of prognosis in patients with oral cavity squamous cell carcinoma

Montero

Yu²,

Palmer

et al. 2013

Cancer

Self Cite

114

View full text Add to dashboard Cite

show abstract

“…5 While imperfect, classification by the TNM system achieves a reasonably precise description and recording of the apparent anatomical extent of disease. 6 Within the TNM system, a particular oral SCC will fall into one of four disease stages. Within each stage, survival rates are similar.…”

Section: Introductionmentioning

confidence: 99%

Oral cavity squamous cell carcinoma survival by biopsy type: a cancer registry study

Frydrych

Parsons

Threlfall

et al. 2010

Australian Dental Journal

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Background: Biopsy of a suspected oral squamous cell carcinoma (SCC) is important for diagnosis. Concerns have been raised about the potential for tumour spread by incisional biopsy techniques. This study aimed to investigate the five-year survival and recurrence of oral SCC after incisional and excisional biopsy in total population data available from the Western Australian Cancer Registry (WACR). Methods: Total population data from the WACR, comprising all primary oral SCC cases diagnosed between 1990 and 1999, were examined. Information extracted included date of birth, gender, biopsy date, biopsy type, disease stage (TNM classification), disease site, date of recurrence and date of death. Records were excluded if the diagnosis was fine needle aspiration based, was not that of oral SCC and if a history was noted of another malignant neoplasm. Incisional and excisional biopsy cases were compared for five-year survival, adjusting for disease stage. Results: No association was found between biopsy type and five-year survival or recurrence amongst individuals with Stage I or II disease. Conclusions: In this study, biopsy type was not associated with survival of oral SCC patients with Stage I or II disease, adding to the evidence that incisional biopsy of oral SCC can be a safe procedure.

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Comparison of Clinical and Pathological Staging in Head and Neck Squamous Cell Carcinoma

Koch¹,

Ridge²,

Forastiere³

et al. 2009

Arch Otolaryngol Head Neck Surg

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Objectives To compare the results of clinical and pathological staging for a large cohort of patients with head and neck squamous cell carcinoma (HNSCC) and to examine patterns and ramifications of the disparity between staging methods. Design Prospective inception cohort (median follow-up, 7 years). Setting Multi-institutional cooperative group study (Eastern Cooperative Oncology Group 4393/Radiation Therapy Oncology Group 9614) involving 17 academic medical centers. Patients A total of 560 patients with new-onset or recurrent HNSCC enrolled during a 7-year period. Interventions Surgical resection with curative intent with or without adjuvant or previous radiotherapy or chemotherapy. Main Outcome Measures Clinical staging and pathological staging and the component TN tumor categories were compared with overall and disease-specific survival. Association of survival with staging was derived by means of the proportional hazards model. Results Of the 501 cases in which both clinical and pathological staging was available, a disparity was found between at least 1 component tumor category assigned by the 2 methods in almost 50% of cases. Both methods showed a strong association of stage with overall survival for the cohort at large. However, pathological nodal category was a superior predictor (P<.001 vs P=.005), whereas there was an advantage to pathological tumor category in predicting disease-specific survival (P=.01). Conclusions Both staging methods are useful in predicting survival, whereas information gained at neck dissection regarding nodal metastases provides some refinement in prognostic results. These findings demonstrate the need for enhanced methods of tumor assessment and apparent benefit of data gathered at neck dissection for accurate disease assessment and stratification.

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Staging of head and neck cancers: Is it time to change the balance between the ideal and the practical?

Cited by 55 publications

References 35 publications

Nomograms for preoperative prediction of prognosis in patients with oral cavity squamous cell carcinoma

Nomograms for preoperative prediction of prognosis in patients with oral cavity squamous cell carcinoma

Oral cavity squamous cell carcinoma survival by biopsy type: a cancer registry study

Comparison of Clinical and Pathological Staging in Head and Neck Squamous Cell Carcinoma

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