Author:
Kang Chung-Jan,Wen Yu-Wen,Lee Shu-Ru,Ng Shu-Hang,Tsai Chi-Ying,Lee Li-Yu,Chu Ying-Hsia,Lin Chien-Yu,Fan Kang-Hsing,Wang Hung-Ming,Hsieh Chia-Hsun,Yeh Chih-Hua,Lin Chih-Hung,Tsao Chung-Kan,Fang Tuan-Jen,Huang Shiang-Fu,Lee Li-Ang,Fang Ku-Hao,Wang Yu-Chien,Lin Wan-Ni,Hsin Li-Jen,Yen Tzu-Chen,Cheng Nai-Ming,Liao Chun-Ta
Abstract
BackgroundTo assess the prognostic significance of different nodal parameters [i.e., number of pathologically positive nodes, log odds of positive lymph nodes, lymph node ratio (LNR), and extra-nodal extension (ENE)] in Taiwanese patients with oral cavity squamous cell carcinoma (OCSCC), and to devise an optimized pN classification system for predicting survival in OCSCC.MethodsA total of 4287 Taiwanese patients with first primary OCSCC and nodal metastases were enrolled. Cox proportional hazards regression analysis with the spline method was applied to identify the optimal cut-off values for LNR, log odds of positive lymph nodes, and number of pathologically positive nodes.ResultsOn multivariable analysis, we identified a LNR ≥0.078/0.079, the presence of at least three pathologically positive nodes, and ENE as independent prognosticators for 5-year disease-specific survival (DSS) and overall survival (OS) rates. We therefore devised a four-point prognostic scoring system according to the presence or absence of each variable. The 5-year DSS and OS rates of patients with scores of 0−3 were 70%/62%/50%/36% (p <0.0001) and 61%/52%/40%25%, respectively (p <0.0001). On analyzing the AJCC 2017 pN classification, patients with pN3a displayed better survival rates than those with pN2 disease. The 5-year DSS and OS rates of patients with pN1/pN2/pN3a/pN3b disease were 72%/60%/67%/43% (p <0.0001) and 63%/51%/67%/33%, respectively (p <0.0001).ConclusionsThree nodal parameters (i.e., a LNR ≥0.078/0.079, the presence of at least three pathologically positive nodes, and ENE) assessed in combination provided a better prognostic stratification than the traditional AJCC pN classification.
Funder
Chang Gung Memorial Hospital, Linkou