Thakar Alok, Thakur Rishikesh, Kakkar Aanchal, Malhotra Rajeev Kumar, Singh Chirom Amit, Sikka Kapil, Kumar Rajeev, Pramanik Raja, Biswas Ahitagni, Bhalla Ashu Seith, Bhaskar Suman, Sharma Atul
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
Laryngoscope. 2021 Oct;131(10):2254-2261. doi: 10.1002/lary.29537. Epub 2021 Apr 1.
To assess the oncological outcome and prognostic factors for primary Oral Squamous Cell Cancer (OSCC) staged as per AJCC 8th pTNM, and treated by the contemporary standard of primary surgery and pathology directed adjuvant radiation-chemoradiation.
A single institution cohort from a tertiary care academic institution in North India. Case inclusion 2013 to 2016; n = 218, median follow-up 35 months. All patients were restaged as per the AJCC 8th pTNM classification. Analysis for Overall Survival (OS), Disease-free Survival(DFS), and factors impacting outcome (Cox proportionate model Multivariate analysis).
AJCC pTNM 7th to 8th edition conversion led to upstaging in 16.5%. Stage-II demonstrated greatest stage migration and apparent improvement in OS and DFS (P < .09). Discordance was noted between the presurgical (clinico-radiologic) and postsurgical (pathological) nodal status in 40.3% (88/218; 54 pathologically upstaged;34 downstaged). Pathological downstaging was particularly significant with advanced stage Gingivo-Buccal Cancers (25/73-34.7%). Stage-I-II early cancers had 3 years. OS-86.7% and DFS-78.8%; Stage-III-IV advanced cancers had 3 years. OS-56.7% and DFS-46.6%. Multivariate analysis identified poorer OS and DFS for age < 40 years (HR-1.8; 2.0), skin involvement (HR-2.1; 2.6) and pN+ status (HR-2.4; 3.5). Bone involvement did not compromise survival in this surgically treated set of patients.
Age < 45 is newly identified as significantly compromising DFS and OS in Oral Cancer. Established factors of skin involvement and pN+ are confirmed as impacting DFS-OS. An apparent improvement in survival in Stage II Cancers is noted as consequent to adoption of AJCC 8th edition staging.
2 (OCEBM 2011-Inception Cohort Study for Prognosis) Laryngoscope, 131:2254-2261, 2021.
评估按照美国癌症联合委员会（AJCC）第8版pTNM分期、采用当代原发性手术及病理指导下辅助放疗-化疗标准治疗的原发性口腔鳞状细胞癌（OSCC）的肿瘤学结局及预后因素。
来自印度北部一家三级医疗学术机构的单中心队列研究。纳入2013年至2016年的病例；n = 218，中位随访时间35个月。所有患者均按照AJCC第8版pTNM分类重新分期。分析总生存期（OS）、无病生存期（DFS）以及影响结局的因素（Cox比例模型多变量分析）。
AJCC pTNM从第7版转换至第8版导致16.5%的病例分期上调。II期显示出最大的分期迁移，且OS和DFS有明显改善（P < 0.09）。术前（临床-放射学）和术后（病理学）淋巴结状态之间存在不一致的情况，占40.3%（88/218；54例病理学分期上调；34例下调）。病理学分期下调在晚期牙龈-颊癌中尤为显著（25/73 - 34.7%）。I-II期早期癌症3年的OS为86.7%，DFS为78.8%；III-IV期晚期癌症3年的OS为56.7%，DFS为46.6%。多变量分析确定年龄<40岁（HR - 1.8；2.0）、皮肤受累（HR - 2.1；2.6）和pN+状态（HR - 2.4；3.5）的患者OS和DFS较差。在这组接受手术治疗的患者中，骨受累并未影响生存。
新发现年龄<45岁会显著影响口腔癌的DFS和OS。已确定的皮肤受累和pN+因素被证实会影响DFS-OS。采用AJCC第8版分期后，II期癌症的生存率有明显改善。
2（OCEBM 2011 - 预后起始队列研究）《喉镜》，131:2254 - 2261，2021年。
