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Yokota Y, Hasegawa T, Yamakawa N, Rin S, Otsuru M, Yamada SI, Hirai E, Ashikaga Y, Yamamoto K, Ueda M, Kirita T, Umeda M, Akashi M, Kurita H, Ohiro Y, Yanamoto S, Okura M. Comparison of the 8th edition of TNM staging of oral cancer with the 7th edition and its prognostic significance using clinical depth of invasion and extranodal extension. Oral Oncol 2023; 145:106519. [PMID: 37459802 DOI: 10.1016/j.oraloncology.2023.106519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES The 8th edition of the International Union Against Cancer Control/American Joint Committee on Cancer Staging System introduced depth of invasion (DOI) and extranodal extension (ENE) into the staging of oral cavity cancer. We evaluated the prognostic ability of this new staging system compared with the 7th edition using clinical DOI (cDOI) and clinical ENE (cENE). MATERIALS AND METHODS We retrospectively reviewed and restaged 2,118 patients with oral squamous cell carcinoma treated between 2001 and 2018 using cDOI and cENE. Overall and disease-specific survival were used as endpoints to compare the prognostic outcomes of the 7th and 8th editions using Harrell's concordance index (C-index). RESULTS In total, 305 (14.4 %) cases were upstaged in the T category, 85 (4.0 %) cases were upstaged in the N category, and 280 (13.2 %) cases were upstaged in the overall TNM stage. The introduction of the cDOI increased the C-index and hazard ratio (HR) for each T category. The introduction of cENE increased the N3b category of 85 cases, bringing the total to 94 cases, thereby widening the differences between each N category. In the 8th edition, the C-index and HR for overall TNM stage increased, and the discrimination between stage groups improved. CONCLUSIONS The 8th edition of the TNM clinical staging system using cDOI and cENE predominantly identified patients with a high mortality rate, thus improving the ability to discriminate and prognosticate oral cancer.
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Affiliation(s)
- Yusuke Yokota
- Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuhiro Yamakawa
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
| | - Shin Rin
- Department of Clinical Oral Oncology, Hokkaido Cancer Center, Sapporo, Japan
| | - Mitsunobu Otsuru
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Shin-Ichi Yamada
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Eiji Hirai
- Oral and Maxillofacial Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Yuichi Ashikaga
- Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Kozo Yamamoto
- Oral and Maxillofacial Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Michihiro Ueda
- Department of Clinical Oral Oncology, Hokkaido Cancer Center, Sapporo, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yoichi Ohiro
- Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Souichi Yanamoto
- Department of Oral Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Masaya Okura
- Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka, Japan; Oral and Maxillofacial Surgery, Saiseikai Matsusaka General Hospital, Mie, Japan.
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Matos LL, Guimarães YLM, Leite AK, Cernea CR. Management of Stage III Oral Cavity Squamous Cell Carcinoma in Light of the New Staging System: a Critical Review. Curr Oncol Rep 2023; 25:107-113. [PMID: 36585962 DOI: 10.1007/s11912-022-01353-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Oral squamous cell carcinoma (OSCC) patients have a poor prognosis, especially in advanced stages. AJCC/UICC staging system 8th edition (TNM8) included depth of invasion (DOI) as part of T staging and stage III has become a heterogeneous group of lesions, composed of patients with larger DOI and/or width. Additionally, stage III includes N1, regardless of the primary tumor width or DOI. The real prognostic value of each of these characteristics and the need for adjuvant treatment for stage III patients is not well established. RECENT FINDINGS TNM8 stratified OSCC into prognostic groups based on overall survival. Extranodal extension, positive or close margins, pT3 or pT4 tumors, pN2 or pN3 nodal disease, nodal disease in levels IV or V, perineural invasion, vascular invasion, and lymphatic invasion are the main adverse features for OSCC, and adjuvant treatment is largely recommended for these patients. Stage III patients should be addressed with caution. So far, there is no significant evidence for recommending or excluding adjuvant treatment for stage III OSCC without adverse features. The authors largely recommend adjuvant radiotherapy for these cases, especially because pT3 without adverse features is rare. Further studies on this topic are necessary.
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Affiliation(s)
- Leandro Luongo Matos
- Head and Neck Surgery, Instituto Do Câncer Do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Icesp, HCFMUSP), Av. Dr. Enéas de Carvalho Aguiar, 255, 8Th Floor, Room 8174, São Paulo, SP, CEP: 05403-000, Brazil. .,Surgical Clinic, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil.
| | - Yasmin Laryssa Moura Guimarães
- Faculdade de Medicina da, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 8Th Floor, Room 8174, São Paulo, SP, Brazil
| | - Ana Kober Leite
- Head and Neck Surgery, Instituto Do Câncer Do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Icesp, HCFMUSP), Av. Dr. Enéas de Carvalho Aguiar, 255, 8Th Floor, Room 8174, São Paulo, SP, CEP: 05403-000, Brazil.,Surgical Clinic, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | - Claudio Roberto Cernea
- Head and Neck Surgery, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 255, 8Th Floor, Room 8174, São Paulo, SP, Brazil
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Salivary miRNAs Expression in Potentially Malignant Disorders of the Oral Mucosa and Oral Squamous Cell Carcinoma: A Pilot Study on miR-21, miR-27b, and miR-181b. Cancers (Basel) 2022; 15:cancers15010291. [PMID: 36612284 PMCID: PMC9818333 DOI: 10.3390/cancers15010291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/16/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
(1) Background: Oral potentially malignant disorders (OPMD) represent a fundamental challenge for clinicians, considering the possibility of progression into oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC). Several studies have examined the expression of miRNAs in humans as diagnostic and prognostic biomarkers. Among these, miR-21, miR-27b, and miR-181b proved to be promising. This cohort study evaluated the different expressions of those miRNAs in the saliva of patients with OPMD and OSCC. (2) Methods: Patients with a clinical diagnosis of OPMD and/or OSCC were enrolled; saliva samples were collected; miRNAs were extracted and quantified via qRT-PCR was performed. Data were analyzed by subgroups based on the histopathological diagnosis (OSCC and the grade of OED) using the ΔΔCt method. Saliva from 10 healthy donors was used as the control. One-way ANOVA and Kruskal-Wallis tests were performed to assess the differences between groups. (3) Results: 23 patients for the OPMD group (6 with no dysplasia, 7 with low-grade, and 10 with high-grade dysplasia) and 10 with OSCC were analyzed. MiR-21 did not show any variation among groups; miR-27b was under-expressed in dysplastic lesions (p = 0.046); miR-181b was upregulated in high-grade dysplasia (p = 0.006), increasing with the degree of dysplasia, and decreasing in OSCCs. (4) Conclusions: Salivary miR-27b and miR-181b could be promising biomarkers for oral dysplasia. Further studies are needed to clarify their feasibility.
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Almangush A, Bello IO, Elseragy A, Hagström J, Haglund C, Kowalski LP, Nieminen P, Coletta RD, Mäkitie AA, Salo T, Leivo I. Tertiary lymphoid structures associate with improved survival in early oral tongue cancer. BMC Cancer 2022; 22:1108. [PMID: 36309667 PMCID: PMC9618224 DOI: 10.1186/s12885-022-10208-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background The clinical significance of tertiary lymphoid structures (TLSs) is not well-documented in early oral tongue squamous cell carcinoma (OTSCC). Methods A total of 310 cases of early (cT1-2N0) OTSCC were included in this multicenter study. Assessment of TLSs was conducted on hematoxylin and eosin-stained sections. TLSs were assessed both in the central part of the tumor and at the invasive front area. Results The presence of TLSs associated with improved survival of early OTSCC as presented by Kaplan–Meier survival analyses for disease-specific survival (P = 0.01) and overall survival (P = 0.006). In multivariable analyses, which included conventional prognostic factors, the absence of TLSs associated with worse disease-specific survival with a hazard ratio (HR) of 1.96 (95% CI 1.09–3.54; P = 0.025) and poor overall survival (HR 1.66, 95% CI 1.11–2.48; P = 0.014). Conclusion Histological evaluation of TLSs predicts survival in early OTSCC. TLSs showed superior prognostic power independent of routine WHO grading and TNM staging system.
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Tu IWH, Shannon NB, Thankappan K, Balasubramanian D, Pillai V, Shetty V, Rangappa V, Chandrasekhar NH, Kekatpure V, Kuriakose MA, Krishnamurthy A, Mitra A, Pattatheyil A, Jain P, Iyer S, Subramaniam N, Iyer NG. Risk Stratification in Oral Cancer: A Novel Approach. Front Oncol 2022; 12:836803. [PMID: 35875164 PMCID: PMC9301677 DOI: 10.3389/fonc.2022.836803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/09/2022] [Indexed: 12/14/2022] Open
Abstract
BackgroundOral squamous cell carcinoma (OSCC) is a common head and neck cancer with high morbidity and mortality. Currently, treatment decisions are guided by TNM staging, which omits important negative prognosticators such as lymphovascular invasion, perineural invasion (PNI), and histologic differentiation. We proposed nomogram models based on adverse pathological features to identify candidates suitable for treatment escalation within each risk group according to the National Comprehensive Cancer Network (NCCN) guidelines.MethodsAnonymized clinicopathologic data of OSCC patients from 5 tertiary healthcare institutions in Asia were divided into 3 risk groups according to the NCCN guidelines. Within each risk group, nomograms were built to predict overall survival based on histologic differentiation, histologic margin involvement, depth of invasion (DOI), extranodal extension, PNI, lymphovascular, and bone invasion. Nomograms were internally validated with precision–recall analysis and the Kaplan–Meier survival analysis.ResultsLow-risk patients with positive pathological nodal involvement and/or positive PNI should be considered for adjuvant radiotherapy. Intermediate-risk patients with gross bone invasion may benefit from concurrent chemotherapy. High-risk patients with positive margins, high DOI, and a high composite score of histologic differentiation, PNI, and the American Joint Committee on Cancer (AJCC) 8th edition T staging should be considered for treatment escalation to experimental therapies in clinical trials.ConclusionNomograms built based on prognostic adverse pathological features can be used within each NCCN risk group to fine-tune treatment decisions for OSCC patients.
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Affiliation(s)
- Irene Wen-Hui Tu
- Department of Head and Neck Surgery Singapore General Hospital and National Cancer Centre Singapore and Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Nicholas Brian Shannon
- Department of Head and Neck Surgery Singapore General Hospital and National Cancer Centre Singapore and Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgical Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Deepak Balasubramanian
- Department of Head and Neck Surgical Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Vijay Pillai
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India
| | - Vivek Shetty
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India
| | - Vidyabhushan Rangappa
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India
| | - Naveen Hedne Chandrasekhar
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India
| | - Vikram Kekatpure
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India
| | - Moni Abraham Kuriakose
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India
| | | | - Arun Mitra
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India
| | - Arun Pattatheyil
- Department of Head and Neck Surgical Oncology, Tata Medical Centre, Kolkata, India
| | - Prateek Jain
- Department of Head and Neck Surgical Oncology, Tata Medical Centre, Kolkata, India
| | - Subramania Iyer
- Department of Head and Neck Surgical Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Narayana Subramaniam
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India
- *Correspondence: N. Gopalakrishna Iyer, ; Narayana Subramaniam,
| | - N. Gopalakrishna Iyer
- Department of Head and Neck Surgery Singapore General Hospital and National Cancer Centre Singapore and Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
- *Correspondence: N. Gopalakrishna Iyer, ; Narayana Subramaniam,
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Carrillo JF, Cruz-Romero C, Avilés-Salas A, Carrillo LC, Ramírez-Ortega MC, Herrera-Goepfert R, Vázquez-Romo R, Figueroa-González G, Altamirano-García JI, Oñate-Ocaña LF. LKB-1 Expression and High-Risk Histopathology are Independent Prognostic Factors for Patients with Oral Cavity Carcinoma. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11544-x. [PMID: 35320428 DOI: 10.1245/s10434-022-11544-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/14/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The expression of liver kinase B1 (LKB-1) has been associated with prognosis in squamous cell carcinoma of the oral cavity (SCCOC). This study aimed to define the prognostic role of LKB-1 expression for patients with SCCOC and the suitability of its integration into a multivariate prognostic model. METHODS A retrospective cohort study of patients with SCCOC was conducted in a cancer center. Expression of LKB-1 was evaluated by immunohistochemistry, and multivariate analysis defined prognostic factors associated with recurrence, recurrence-free survival (RFS), and overall survival (OS). The logistic regression model was used to construct a predictive computer software program. RESULTS Of the 201 patients in this study, 104 (51.7%) experienced recurrence of their disease. Lower expression of LKB-1, high-risk histopathology, and advanced tumor-node-metastasis (TNM) stages were independent factors via multivariate analysis associated with the increased recurrence risk, poor RFS, and poor OS. If lack of LKB-1 expression is considered the reference category, the factors independently associated with recurrence were low (odds ratio [OR], 0.157; 95% confidence interval [CI], 0.044-0.557), intermediate (OR, 0.073; 95% CI, 0.017-0.319), and intense (OR, 0.047; 95% CI, 0.007-0.304) expression of LKB-1. This model permitted construction of a computer software program capable of prediction with receiver operating characteristic analysis (area under the curve, 0.925) and led to the definition of five prognostic groups with a biologic gradient. CONCLUSION These results suggest that LKB-1 expression in patients with SCCOC is of robust prognostic value and complements the TNM staging system. The proposed model requires external validation in prospective observational studies.
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Affiliation(s)
- José F Carrillo
- Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Christian Cruz-Romero
- Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Liliana C Carrillo
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Margarita C Ramírez-Ortega
- Subdirección de Investigación Básica, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Rafael Vázquez-Romo
- Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Gabriela Figueroa-González
- Unidad de Investigación Multidisciplinaria (UMIEZ), Facultad de Estudios Superiores Zaragoza, UNAM, Mexico City, Mexico
| | | | - Luis F Oñate-Ocaña
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico City, Mexico.
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Almangush A, Bello IO, Heikkinen I, Hagström J, Haglund C, Kowalski LP, Coletta RD, Mäkitie AA, Salo T, Leivo I. Improving Risk Stratification of Early Oral Tongue Cancer with TNM-Immune (TNM-I) Staging System. Cancers (Basel) 2021; 13:cancers13133235. [PMID: 34209490 PMCID: PMC8267637 DOI: 10.3390/cancers13133235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/08/2021] [Accepted: 06/23/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Some patients with early-stage oral tongue cancer suffer from poor survival. The currently used classification requires further improvement to better predict the prognosis. Immune-related parameters (such as assessment of infiltrating lymphocytes) can be used as a modifier for the classification and that can aid in improving the prognostication. We included 290 cases of early-stage oral tongue cancer in this study. Lymphocytes were scored and divided as low or high and incorporated in the traditional tumor-node-metastasis (TNM) classification to form our proposed TNM-Immune staging system. The TNM-Immune staging system allowed for a significant distinction between T1 and T2. The TNM-Immune staging system showed a powerful ability to identify cases with poor survival. TNM-Immune staging forms a step towards a more personalized classification of early-stage oral tongue cancer. Abstract Although patients with early-stage oral tongue squamous cell carcinoma (OTSCC) show better survival than those with advanced disease, there is still a number of early-stage cases who will suffer from recurrence, cancer-related mortality and worse overall survival. Incorporation of an immune descriptive factor in the staging system can aid in improving risk assessment of early OTSCC. A total of 290 cases of early-stage OTSCC re-classified according to the American Joint Committee on Cancer (AJCC 8) staging were included in this study. Scores of tumor-infiltrating lymphocytes (TILs) were divided as low or high and incorporated in TNM AJCC 8 to form our proposed TNM-Immune system. Using AJCC 8, there were no significant differences in survival between T1 and T2 tumors (p > 0.05). Our proposed TNM-Immune staging system allowed for significant discrimination in risk between tumors of T1N0M0-Immune vs. T2N0M0-Immune. The latter associated with a worse overall survival with hazard ratio (HR) of 2.87 (95% CI 1.92–4.28; p < 0.001); HR of 2.41 (95% CI 1.26–4.60; p = 0.008) for disease-specific survival; and HR of 1.97 (95% CI 1.13–3.43; p = 0.017) for disease-free survival. The TNM-Immune staging system showed a powerful ability to identify cases with worse survival. The immune response is an important player which can be assessed by evaluating TILs, and it can be implemented in the staging criteria of early OTSCC. TNM-Immune staging forms a step towards a more personalized classification of early OTSCC.
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Affiliation(s)
- Alhadi Almangush
- Department of Pathology, University of Helsinki, 00014 Helsinki, Finland; (I.O.B.); (I.H.); (J.H.); (T.S.)
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland;
- Institute of Biomedicine, Pathology, University of Turku, 20520 Turku, Finland;
- Faculty of Dentistry, Misurata University, Misurata 2478, Libya
- Correspondence: ; Tel.: +358-45-2044668
| | - Ibrahim O. Bello
- Department of Pathology, University of Helsinki, 00014 Helsinki, Finland; (I.O.B.); (I.H.); (J.H.); (T.S.)
- Department of Oral Medicine and Diagnostic Sciences, King Saud University College of Dentistry, Riyadh 11545, Saudi Arabia
| | - Ilkka Heikkinen
- Department of Pathology, University of Helsinki, 00014 Helsinki, Finland; (I.O.B.); (I.H.); (J.H.); (T.S.)
- Department of Oral and Maxillofacial Diseases, University of Helsinki, 00014 Helsinki, Finland
| | - Jaana Hagström
- Department of Pathology, University of Helsinki, 00014 Helsinki, Finland; (I.O.B.); (I.H.); (J.H.); (T.S.)
- Research Programs Unit, Translational Cancer Medicine, University of Helsinki, 00014 Helsinki, Finland;
- Department of Oral Pathology and Radiology, University of Turku and Turku University Hospital, 20520 Turku, Finland
| | - Caj Haglund
- Research Programs Unit, Translational Cancer Medicine, University of Helsinki, 00014 Helsinki, Finland;
- Department of Surgery, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo 01509-900, Brazil;
| | - Ricardo D. Coletta
- Department of Oral Diagnosis, School of Dentistry, University of Campinas, Piracicaba, São Paulo 13083-970, Brazil;
| | - Antti A. Mäkitie
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland;
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, 00130 Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, 17177 Stockholm, Sweden
| | - Tuula Salo
- Department of Pathology, University of Helsinki, 00014 Helsinki, Finland; (I.O.B.); (I.H.); (J.H.); (T.S.)
- Department of Oral and Maxillofacial Diseases, University of Helsinki, 00014 Helsinki, Finland
- Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, 90220 Oulu, Finland
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku, 20520 Turku, Finland;
- Turku University Hospital, 20521 Turku, Finland
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Zhou J, Li H, Cheng B, Cao R, Zou F, Yang D, Liu X, Song M, Wu T. Derivation and Validation of a Prognostic Scoring Model Based on Clinical and Pathological Features for Risk Stratification in Oral Squamous Cell Carcinoma Patients: A Retrospective Multicenter Study. Front Oncol 2021; 11:652553. [PMID: 34123806 PMCID: PMC8195273 DOI: 10.3389/fonc.2021.652553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022] Open
Abstract
Objective To develop and validate a simple-to-use prognostic scoring model based on clinical and pathological features which can predict overall survival (OS) of patients with oral squamous cell carcinoma (OSCC) and facilitate personalized treatment planning. Materials and Methods OSCC patients (n = 404) from a public hospital were divided into a training cohort (n = 282) and an internal validation cohort (n = 122). A total of 12 clinical and pathological features were included in Kaplan-Meier analysis to identify the factors associated with OS. Multivariable Cox proportional hazards regression analysis was performed to further identify important variables and establish prognostic models. Nomogram was generated to predict the individual's 1-, 3- and 5-year OS rates. The performance of the prognostic scoring model was compared with that of the pathological one and the AJCC TNM staging system by the receiver operating characteristic curve (ROC), concordance index (C-index), calibration curve, and decision curve analysis (DCA). Patients were classified into high- and low-risk groups according to the risk scores of the nomogram. The nomogram-illustrated model was independently tested in an external validation cohort of 95 patients. Results Four significant variables (physical examination-tumor size, imaging examination-tumor size, pathological nodal involvement stage, and histologic grade) were included into the nomogram-illustrated model (clinical-pathological model). The area under the ROC curve (AUC) of the clinical-pathological model was 0.687, 0.719, and 0.722 for 1-, 3- and 5-year survival, respectively, which was superior to that of the pathological model (AUC = 0.649, 0.707, 0.717, respectively) and AJCC TNM staging system (AUC = 0.628, 0.668, 0.677, respectively). The clinical-pathological model exhibited improved discriminative power compared with pathological model and AJCC TNM staging system (C-index = 0.755, 0.702, 0.642, respectively) in the external validation cohort. The calibration curves and DCA also displayed excellent predictive performances. Conclusion This clinical and pathological feature based prognostic scoring model showed better predictive ability compared with the pathological one, which would be a useful tool of personalized accurate risk stratification and precision therapy planning for OSCC patients.
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Affiliation(s)
- Jiaying Zhou
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Huan Li
- Department of ICU, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Bin Cheng
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Ruoyan Cao
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Fengyuan Zou
- Department of Data Sciences, AID Cloud Technology Co., Ltd, Guangzhou, China
| | - Dong Yang
- Department of Data Sciences, AID Cloud Technology Co., Ltd, Guangzhou, China
| | - Xiang Liu
- Department of Data Sciences, AID Cloud Technology Co., Ltd, Guangzhou, China
| | - Ming Song
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Tong Wu
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
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