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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2012

01-12-2012 | Head and Neck Oncology

Analysis and Comparison of the 7th Edition American Joint Committee on Cancer (AJCC) Nodal Staging System for Metastatic Cutaneous Squamous Cell Carcinoma of the Head and Neck

Authors: Jonathan R. Clark, MBBS, Pavlina Rumcheva, PhD, Michael J Veness, MD

Published in: Annals of Surgical Oncology | Issue 13/2012

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Abstract

Background

The American Joint Committee on Cancer (AJCC) substantially changed the staging of cutaneous squamous cell carcinoma (cSCC) in the 7th edition of its staging manual. We aim to compare the 7th edition AJCC staging of nodal metastases from cSCC with the N1S3 staging system.

Methods

Analysis of 603 patients from two prospective cancer center databases was performed. Multivariable analysis was performed using a Cox proportional hazards competing risk model adjusting for the effect of immunosuppression, treating institution, adjuvant radiotherapy, nodal margins, and extracapsular spread. Criteria used for comparing staging systems were distribution of patients, stratification of patients according to risk of death from cSCC, and model performance.

Results

The N1S3 staging system functioned well in terms of distribution and stratification of patients. The distribution of patients within the AJCC staging system was problematic with three groups (N2a, N2c, and N3) containing less than 10 % of patients without any prognostic relevance. Stratification of patients within the AJCC staging system was poor in terms of monotonicity (N2c) and distinctiveness (N2a). The performance of the AJCC and N1S3 staging systems was similar despite the AJCC staging being more complex.

Conclusions

The N1S3 staging system for cSCC is preferred on the grounds of better distribution, stratification, and parsimony.
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Metadata
Title
Analysis and Comparison of the 7th Edition American Joint Committee on Cancer (AJCC) Nodal Staging System for Metastatic Cutaneous Squamous Cell Carcinoma of the Head and Neck
Authors
Jonathan R. Clark, MBBS
Pavlina Rumcheva, PhD
Michael J Veness, MD
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 13/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2504-2

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