Amit M, Yen T C, Liao C T, Chaturvedi P, Agarwal J P, Kowalski L P, Kohler Hugo F, Ebrahimi A, Clark J R, Cernea C R, Brandao S J, Kreppel M, Zöller J, Fliss M D, Bachar G, Shpitzer T, Bolzoni V A, Patel P R, Jonnalagadda S, Robbins K T, Iyer N G, Skanthakumar T, Shah J P, Patel S G, Gil Z
The Laboratory for Applied Cancer Research, Clinical Research Institute at Rambam, Rappaport Institute for Research in Medical Science, Haifa, Israel.
Department of Otolaryngology, Head and Neck Surgery, Head and Neck Center, Rambam Medical Center, Rappaport School of Medicine, The Technion, Israel Institute of Technology, 66036, Haifa, Israel.
Ann Surg Oncol. 2015 Dec;22 Suppl 3(Suppl 3):S985-91. doi: 10.1245/s10434-015-4842-3. Epub 2015 Aug 28.
The American Joint Committee on Cancer (AJCC) stage III classification of oral cavity squamous cell carcinoma (OCSCC) represents a heterogeneous group of patients with early local disease with regional metastases (T1N1 and T2N1) and advanced local disease with or without regional metastasis (T3N0 and T3N1).
The aim of this study was to evaluate prognostic heterogeneity in the stage III category.
An international retrospective multicenter study of 1815 patients who were treated for OCSCC from 2003 to 2011.
Kaplan-Meier survival analysis and multivariate models of stage III patients revealed better overall survival (OS; HR 2.12, 95 % CI 1.03-4.15; p = 0.01) and disease-specific survival (DSS; HR 1.7, 95 % CI 1.16-4.12; p = 0.04) rates for patients with T1-2N1/T3N0 disease than for patients with T3N1 disease. The outcomes of patients with T3N1 and stage IVa disease were similar (p = 0.89 and p = 0.78 for OS and DSS, respectively). Modifying stage classification by transferring the T3N1 category to the stage VIa group resulted in a better prognostic performance [Harrell's concordance index, C index 0.76; Akaike's Information Criterion (AIC) 4131.6] compared with the AJCC 7th edition staging system (C index 0.65; AIC 4144.9) for OS. When DSS was assessed, the suggested staging system remained the best performing model (C index 0.71; AIC 1061.3) compared with the current AJCC 7th edition staging (C index 0.64; AIC 1066.2).
The prognosis of T3N1 and stage IVa disease are similar in OCSCC, suggesting that these categories could be combined in future revisions of the nodal staging system to enhance prognostic accuracy.
美国癌症联合委员会（AJCC）对口腔鳞状细胞癌（OCSCC）的III期分类代表了一组异质性患者，包括局部疾病早期伴区域转移（T1N1和T2N1）以及局部疾病晚期伴或不伴区域转移（T3N0和T3N1）。
本研究的目的是评估III期类别中的预后异质性。
一项对2003年至2011年期间接受OCSCC治疗的1815例患者进行的国际回顾性多中心研究。
Kaplan-Meier生存分析和III期患者的多变量模型显示，T1-2N1/T3N0疾病患者的总生存期（OS；风险比2.12，95%置信区间1.03 - 4.15；p = 0.01）和疾病特异性生存期（DSS；风险比1.7，95%置信区间1.16 - 4.12；p = 0.04）率高于T3N1疾病患者。T3N1和IVa期疾病患者的结局相似（OS和DSS的p值分别为0.89和0.78）。将T3N1类别转移至VIa期组来修改分期分类，与AJCC第7版分期系统相比，在OS方面具有更好的预后性能[Harrell一致性指数，C指数0.76；赤池信息准则（AIC）4131.6]。在评估DSS时，与当前的AJCC第7版分期相比，建议的分期系统仍是性能最佳的模型（C指数0.71；AIC 1061.3）（C指数0.64；AIC 1066.2）。
在OCSCC中，T3N1和IVa期疾病的预后相似，这表明在未来的淋巴结分期系统修订中可将这些类别合并以提高预后准确性。
