Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Eur J Cancer. 2021 Feb;144:169-177. doi: 10.1016/j.ejca.2020.11.019. Epub 2020 Dec 22.
The last revision of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual included a specific system for cutaneous squamous cell carcinoma (CSCC) of the head and neck. Here, we assessed the prognostic performance of six candidate modified T-classification models in head and neck CSCC patients.
Analysis of 916 patients with head and neck CSCC given treatment with curative intent at The University of Texas MD Anderson Cancer Center between 1995 and 2019 was performed. The main outcome was disease-specific survival (DSS), and the impact of depth of invasion (DOI) was analyzed using multivariable regression models. Candidate models were developed using the optimal DOI cut points for each AJCC T classification based on goodness of fit of the model and the simplicity of the model. Staging systems were compared using Harrell's concordance index.
Median age was 70 years (range, 19-97years) and median follow-up time of 22 months (range, 1-250months). The median DOI was 6.0 mm (range, 0.1-70.0 mm). The five-year DSS rate was 80.7% (95%CI, 77.4-83.7%). We found significant association between DOI (hazard ratio, 1.21 [95%CI: 1.01-1.43]) and DSS on multivariable analysis. Based on a low Akaike information criterion score, improvement in the concordance index, and Kaplan-Meier curves, model 6 surpassed the AJCC staging system.
Incorporation of DOI in the current AJCC staging system improves discrimination of T classifications in head and neck CSCC patients.
The current staging system for head and neck cutaneous squamous cell carcinoma demonstrates wide prognostic variability and provides suboptimal risk stratification. Incorporation of depth of invasion in the T-classification system improves risk prediction and patient counseling.
We propose improved head and neck cutaneous squamous cell carcinoma T staging that will include depth of invasion and should be considered in future versions of the American Joint Committee on Cancer after external validation.
美国癌症联合委员会（AJCC）癌症分期手册的最后一次修订包括了头颈部皮肤鳞状细胞癌（CSCC）的特定系统。在这里，我们评估了 6 种候选改良 T 分类模型在头颈部 CSCC 患者中的预后表现。
对 1995 年至 2019 年期间在德克萨斯大学 MD 安德森癌症中心接受根治性治疗的 916 例头颈部 CSCC 患者进行分析。主要结局是疾病特异性生存（DSS），并使用多变量回归模型分析侵袭深度（DOI）的影响。候选模型是根据模型拟合度和模型简单性，使用基于 AJCC T 分类的最佳 DOI 切点来开发的。使用 Harrell 一致性指数比较分期系统。
中位年龄为 70 岁（范围，19-97 岁），中位随访时间为 22 个月（范围，1-250 个月）。中位 DOI 为 6.0mm（范围，0.1-70.0mm）。五年 DSS 率为 80.7%（95%CI，77.4-83.7%）。我们在多变量分析中发现 DOI（风险比，1.21[95%CI：1.01-1.43]）与 DSS 之间存在显著关联。基于低 Akaike 信息准则评分、一致性指数的改善和 Kaplan-Meier 曲线，模型 6 优于 AJCC 分期系统。
在当前 AJCC 分期系统中纳入 DOI 可提高头颈部 CSCC 患者 T 分类的区分度。
当前的头颈部皮肤鳞状细胞癌分期系统显示出广泛的预后变异性，并提供了不理想的风险分层。在 T 分类系统中纳入侵袭深度可提高风险预测和患者咨询。
我们提出了改良的头颈部皮肤鳞状细胞癌 T 分期，将包括侵袭深度，并应在未来的 AJCC 版本中考虑，在外部验证后。
