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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2018

01-06-2018 | Head and Neck Oncology

Analysis and Comparison of the 8th Edition American Joint Committee on Cancer (AJCC) Nodal Staging System in Cutaneous and Oral Squamous Cell Cancer of the Head and Neck

Authors: Nikolaus Moeckelmann, MD, Ardalan Ebrahimi, MBBS (Hons), FRACS, Richard Dirven, MD, Jessica Liu, MBBS, Tsu-Hui (Hubert) Low, MBBS (Hons), FRACS, Ruta Gupta, MD, MBBS, FRCPA, Bruce Ashford, BDSc (Hons), MBBS, FRACS, Sydney Ch’ng, PhD, MBBS, FRACS, Carsten E. Palme, MBBS, FRACS, Jonathan R. Clark, MBBS, M Biostat, FRACS

Published in: Annals of Surgical Oncology | Issue 6/2018

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Abstract

Background

The American Joint Committee on Cancer (AJCC) uses the same nodal staging system for cutaneous and mucosal squamous cell carcinoma of the head and neck in its 8th edition (AJCC 8) despite differences in the etiology, risk factors, and clinical behavior of the two diseases. This study aims to evaluate the performance of the AJCC 8 nodal staging system by direct comparison of cutaneous (cSCC) versus oral squamous cell carcinoma (oSCC) patients.

Methods

Patients with metastatic cSCC (N = 382) and oSCC (N = 325) were identified from a prospective database (years 1987–2016). Multivariable analysis was performed using Cox proportional hazards competing risk model. To assess staging system performance, an explained variation measure (proportion of variation explained, PVE) as well as a discrimination measure (Harrell’s concordance index, C-index) were used.

Results

Inclusion of extranodal extension (ENE) in AJCC 8 increased the proportion of patients in N3b category (48.7% in cSCC, 40.3% in oSCC). AJCC 8 stratified poorly with regards to risk of death from cSCC and oSCC and showed limited monotonicity of the nodal categories. Estimates of model performance revealed modest predictive capacity for overall survival (OS) and disease-specific survival (DSS) in oSCC (Harrell’s C of 0.66 in both) and weak predictive capacity in cSCC (Harrell’s C of 0.58 and 0.61, respectively).

Conclusions

The AJCC 8 nodal staging system performs poorly in terms of stratifying survival by N category, especially in cSCC. The data indicate that cSCC merits an independent nodal staging system from that for mucosal SCC.
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Metadata
Title
Analysis and Comparison of the 8th Edition American Joint Committee on Cancer (AJCC) Nodal Staging System in Cutaneous and Oral Squamous Cell Cancer of the Head and Neck
Authors
Nikolaus Moeckelmann, MD
Ardalan Ebrahimi, MBBS (Hons), FRACS
Richard Dirven, MD
Jessica Liu, MBBS
Tsu-Hui (Hubert) Low, MBBS (Hons), FRACS
Ruta Gupta, MD, MBBS, FRCPA
Bruce Ashford, BDSc (Hons), MBBS, FRACS
Sydney Ch’ng, PhD, MBBS, FRACS
Carsten E. Palme, MBBS, FRACS
Jonathan R. Clark, MBBS, M Biostat, FRACS
Publication date
01-06-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6340-x

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