Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia.
Sydney Head and Neck Cancer Institute, Sydney, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.
Surgery. 2021 Nov;170(5):1467-1473. doi: 10.1016/j.surg.2021.04.019. Epub 2021 Jun 12.
The eighth edition of the American Joint Committee on Cancer Staging Manual includes a staging system for head and neck cutaneous squamous cell carcinoma for the first time. The pN categories for head and neck cutaneous squamous cell carcinoma and mucosal squamous cell carcinoma are identical, despite the vastly different biological behavior of these diseases. This study aimed to survey head and neck cancer specialists' views regarding the clinical utility of the American Joint Committee on Cancer Staging Manual for head and neck cutaneous squamous cell carcinoma and to identify avenues for improvement.
An electronic survey of 19 questions relating to the prognostic utility of the staging system was designed based on the findings of a literature review. The survey was distributed internationally to specialists managing head and neck cutaneous squamous cell carcinoma.
Literature review identified 9 articles describing primary research relevant to the performance of the American Joint Committee on Cancer Staging Manual for head and neck cutaneous squamous cell carcinoma, which recognized a lack of homogeneity, monotonicity, and distinctiveness in the pN staging system. One hundred and five survey responses were received: 71% indicated that mucosal and head and neck cutaneous squamous cell carcinoma require different nodal staging categories; 63% indicated that immunosuppression should be included in the staging system; 70% thought that soft tissue metastases portend a worse prognosis compared with extranodal extension; 38% almost never saw pN3a tumors; and 40% felt that the N stage is a poor predictor of survival.
The views of head and neck cancer specialists across disciplines and countries align with evidence suggesting that head and neck cutaneous squamous cell carcinoma merits a staging system distinct from mucosal squamous cell carcinoma, that immunosuppression should be considered in prognostication, and that the use of extranodal extension should be modified.
第八版美国癌症联合委员会分期手册首次为头颈部皮肤鳞状细胞癌制定了分期系统。头颈部皮肤鳞状细胞癌和黏膜鳞状细胞癌的 pN 分期类别相同，尽管这两种疾病的生物学行为有很大差异。本研究旨在调查头颈部癌症专家对头颈部皮肤鳞状细胞癌的美国癌症联合委员会分期手册的临床实用性的看法，并确定改进的途径。
根据文献回顾的结果，设计了一个包含 19 个问题的电子调查，涉及分期系统的预后实用性。该调查在国际范围内分发给管理头颈部皮肤鳞状细胞癌的专家。
文献回顾确定了 9 篇描述与头颈部皮肤鳞状细胞癌的美国癌症联合委员会分期手册表现相关的主要研究的文章，这些文章认识到头颈皮肤鳞状细胞癌的 pN 分期系统缺乏同质性、单调性和独特性。共收到 105 份调查回复：71%的人表示黏膜和头颈部皮肤鳞状细胞癌需要不同的淋巴结分期类别；63%的人表示免疫抑制应纳入分期系统；70%的人认为软组织转移预示着比结外扩展更差的预后；38%的人几乎从未见过 pN3a 肿瘤；40%的人认为 N 期是生存的不良预测因素。
跨学科和国家的头颈部癌症专家的观点与证据一致，表明头颈部皮肤鳞状细胞癌需要一个与黏膜鳞状细胞癌不同的分期系统，免疫抑制应在预后中考虑，结外扩展的使用应加以修改。
