The Prognosis of N2b and N2c Lymph Node Disease in Oral Squamous Cell Carcinoma Is Determined by the Number of Metastatic Lymph Nodes Rather Than Laterality
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Citações na Scopus
46
Tipo de produção
article
Data de publicação
2014
Editora
WILEY-BLACKWELL
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Autores
EBRAHIMI, Ardalan
GIL, Ziv
AMIT, Moran
YEN, Tzu-Chen
LIAO, Chun-Ta
CHATURVEDI, Pankaj
AGARWAL, Jai Prakash
KOWALSKI, Luiz P.
KOHLER, Hugo F.
KREPPEL, Matthias
Autor de Grupo de pesquisa
Int Consortium Outcome Res ICOR
Editores
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Organizadores
Citação
CANCER, v.120, n.13, p.1968-1974, 2014
Resumo
BACKGROUND: A study was conducted to assess for prognostic heterogeneity within the N2b and N2c classifications for oral cancer based on the number of metastatic lymph nodes and to determine whether laterality of neck disease provides additional prognostic information. METHODS: An international multicenter study of 3704 patients with oral cancer undergoing surgery with curative intent was performed. The endpoints of interest were disease-specific survival and overall survival. Model fit was assessed by the Akaike Information Criterion and comparison of models with and without the covariate of interest using a likelihood ratio test. RESULTS: The median number of metastatic lymph nodes was significantly higher in patients with N2c disease compared to those with N2b disease (P < .001). In multivariable analyses stratified by study center, the addition of the number of metastatic lymph nodes improved model fit beyond existing N classification. Next, the authors confirmed significant heterogeneity in prognosis based on the number of metastatic lymph nodes (<= 2, 3-4, and >= 5) in patients with both N2b and N2c disease (P < .001). A proposed reclassification combining N2b and N2c disease based on the number of metastatic lymph nodes demonstrated significant improvement in prognostic accuracy compared with the American Joint Committee on Cancer staging system, and no improvement was noted with the addition of a covariate for contralateral or bilateral neck disease (P = .472). CONCLUSIONS: The prognosis of patients with oral cancer with N2b and N2c disease appears to be similar after adequate adjustment for the burden of lymph node metastases, irrespective of laterality. Based on this finding, the authors propose a modified lymph node staging system that requires external validation before implementation in clinical practice. (C) 2014 American Cancer Society.
Palavras-chave
head and neck neoplasms, oral squamous cell carcinoma, lymph node metastases, cancer staging, prognosis
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