The American Joint Committee on Cancer staging for metastatic head and neck cutaneous squamous cell carcinoma: A multi-institutional study of within-stage heterogeneity and impact on prognostic performance

Ardalan Ebrahimi; Peter P. Luk; Hubert Low; Lachlan McDowell; Matthew J.R. Magarey; Paul N. Smith; Diana M. Perriman; Bruce Shadbolt; Michael Veness; Ruta Gupta; Jonathan R. Clark

doi:10.1002/hed.26369

The American Joint Committee on Cancer staging for metastatic head and neck cutaneous squamous cell carcinoma: A multi-institutional study of within-stage heterogeneity and impact on prognostic performance

Ardalan Ebrahimi^*, Peter P. Luk, Hubert Low, Lachlan McDowell, Matthew J.R. Magarey, Paul N. Smith, Diana M. Perriman, Bruce Shadbolt, Michael Veness, Ruta Gupta, Jonathan R. Clark

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

7 Citations (Scopus)

Abstract

Background: The American Joint Committee on Cancer (AJCC) staging for head and neck cutaneous squamous cell carcinoma (HNcSCC) stratifies risk poorly. We hypothesized that this results from prognostic heterogeneity within N and TNM groups. Methods: Retrospective analysis of disease-specific survival (DSS) in a multicenter study of 1146 patients with nodal metastases from HNcSCC. Results: The majority of patients were classified as pN2a or pN3b (83.1%) and TNM stage IV (90.6%). On multivariate analysis, there was statistically significant prognostic heterogeneity within these groups based on the number and size of nodal metastases, immunosuppression, and perineural invasion. When stage IV patients were categorized into low, moderate, and high-risk groups based on adverse features, there was wide variation in prognosis with 5-year DSS ranging from 90% to 60% (P <.001). Conclusions: The AJCC staging system stratifies risk poorly in HNcSCC due to significant prognostic heterogeneity within pN2a, pN3b, and stage IV groups.

Original language	English
Pages (from-to)	3235-3242
Number of pages	8
Journal	Head and Neck
Volume	42
Issue number	11
DOIs	https://doi.org/10.1002/hed.26369
Publication status	Published - 1 Nov 2020

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Ebrahimi, A., Luk, P. P., Low, H., McDowell, L., Magarey, M. J. R., Smith, P. N., Perriman, D. M., Shadbolt, B., Veness, M., Gupta, R., & Clark, J. R. (2020). The American Joint Committee on Cancer staging for metastatic head and neck cutaneous squamous cell carcinoma: A multi-institutional study of within-stage heterogeneity and impact on prognostic performance. Head and Neck, 42(11), 3235-3242. https://doi.org/10.1002/hed.26369

@article{dbb6c4f4f85d4ed0b17930a2e744c4d3,

title = "The American Joint Committee on Cancer staging for metastatic head and neck cutaneous squamous cell carcinoma: A multi-institutional study of within-stage heterogeneity and impact on prognostic performance",

abstract = "Background: The American Joint Committee on Cancer (AJCC) staging for head and neck cutaneous squamous cell carcinoma (HNcSCC) stratifies risk poorly. We hypothesized that this results from prognostic heterogeneity within N and TNM groups. Methods: Retrospective analysis of disease-specific survival (DSS) in a multicenter study of 1146 patients with nodal metastases from HNcSCC. Results: The majority of patients were classified as pN2a or pN3b (83.1%) and TNM stage IV (90.6%). On multivariate analysis, there was statistically significant prognostic heterogeneity within these groups based on the number and size of nodal metastases, immunosuppression, and perineural invasion. When stage IV patients were categorized into low, moderate, and high-risk groups based on adverse features, there was wide variation in prognosis with 5-year DSS ranging from 90% to 60% (P <.001). Conclusions: The AJCC staging system stratifies risk poorly in HNcSCC due to significant prognostic heterogeneity within pN2a, pN3b, and stage IV groups.",

keywords = "cancer staging, cutaneous squamous cell carcinoma, head and neck cancer, lymph node metastasis, prognosis",

author = "Ardalan Ebrahimi and Luk, {Peter P.} and Hubert Low and Lachlan McDowell and Magarey, {Matthew J.R.} and Smith, {Paul N.} and Perriman, {Diana M.} and Bruce Shadbolt and Michael Veness and Ruta Gupta and Clark, {Jonathan R.}",

note = "Publisher Copyright: {\textcopyright} 2020 Wiley Periodicals LLC",

year = "2020",

month = nov,

day = "1",

doi = "10.1002/hed.26369",

language = "English",

volume = "42",

pages = "3235--3242",

journal = "Head and Neck",

issn = "1043-3074",

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Ebrahimi, A, Luk, PP, Low, H, McDowell, L, Magarey, MJR, Smith, PN, Perriman, DM, Shadbolt, B, Veness, M, Gupta, R & Clark, JR 2020, 'The American Joint Committee on Cancer staging for metastatic head and neck cutaneous squamous cell carcinoma: A multi-institutional study of within-stage heterogeneity and impact on prognostic performance', Head and Neck, vol. 42, no. 11, pp. 3235-3242. https://doi.org/10.1002/hed.26369

The American Joint Committee on Cancer staging for metastatic head and neck cutaneous squamous cell carcinoma: A multi-institutional study of within-stage heterogeneity and impact on prognostic performance. / Ebrahimi, Ardalan; Luk, Peter P.; Low, Hubert et al.
In: Head and Neck, Vol. 42, No. 11, 01.11.2020, p. 3235-3242.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The American Joint Committee on Cancer staging for metastatic head and neck cutaneous squamous cell carcinoma

T2 - A multi-institutional study of within-stage heterogeneity and impact on prognostic performance

AU - Ebrahimi, Ardalan

AU - Luk, Peter P.

AU - Low, Hubert

AU - McDowell, Lachlan

AU - Magarey, Matthew J.R.

AU - Smith, Paul N.

AU - Perriman, Diana M.

AU - Shadbolt, Bruce

AU - Veness, Michael

AU - Gupta, Ruta

AU - Clark, Jonathan R.

PY - 2020/11/1

Y1 - 2020/11/1

N2 - Background: The American Joint Committee on Cancer (AJCC) staging for head and neck cutaneous squamous cell carcinoma (HNcSCC) stratifies risk poorly. We hypothesized that this results from prognostic heterogeneity within N and TNM groups. Methods: Retrospective analysis of disease-specific survival (DSS) in a multicenter study of 1146 patients with nodal metastases from HNcSCC. Results: The majority of patients were classified as pN2a or pN3b (83.1%) and TNM stage IV (90.6%). On multivariate analysis, there was statistically significant prognostic heterogeneity within these groups based on the number and size of nodal metastases, immunosuppression, and perineural invasion. When stage IV patients were categorized into low, moderate, and high-risk groups based on adverse features, there was wide variation in prognosis with 5-year DSS ranging from 90% to 60% (P <.001). Conclusions: The AJCC staging system stratifies risk poorly in HNcSCC due to significant prognostic heterogeneity within pN2a, pN3b, and stage IV groups.

AB - Background: The American Joint Committee on Cancer (AJCC) staging for head and neck cutaneous squamous cell carcinoma (HNcSCC) stratifies risk poorly. We hypothesized that this results from prognostic heterogeneity within N and TNM groups. Methods: Retrospective analysis of disease-specific survival (DSS) in a multicenter study of 1146 patients with nodal metastases from HNcSCC. Results: The majority of patients were classified as pN2a or pN3b (83.1%) and TNM stage IV (90.6%). On multivariate analysis, there was statistically significant prognostic heterogeneity within these groups based on the number and size of nodal metastases, immunosuppression, and perineural invasion. When stage IV patients were categorized into low, moderate, and high-risk groups based on adverse features, there was wide variation in prognosis with 5-year DSS ranging from 90% to 60% (P <.001). Conclusions: The AJCC staging system stratifies risk poorly in HNcSCC due to significant prognostic heterogeneity within pN2a, pN3b, and stage IV groups.

KW - cancer staging

KW - cutaneous squamous cell carcinoma

KW - head and neck cancer

KW - lymph node metastasis

KW - prognosis

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U2 - 10.1002/hed.26369

DO - 10.1002/hed.26369

M3 - Article

SN - 1043-3074

VL - 42

SP - 3235

EP - 3242

JO - Head and Neck

JF - Head and Neck

IS - 11

ER -

The American Joint Committee on Cancer staging for metastatic head and neck cutaneous squamous cell carcinoma: A multi-institutional study of within-stage heterogeneity and impact on prognostic performance

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