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Validation of the Risk Model: High-Risk Classification and Tumor Pattern of Invasion Predict Outcome for Patients with Low-Stage Oral Cavity Squamous Cell Carcinoma

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Abstract

The Risk Model is a validated outcome predictor for patients with head and neck squamous cell carcinoma (Brandwein-Gensler et al. in Am J Surg Pathol 20:167–178, 2005; Am J Surg Pathol 34:676–688, 2010). This model may potentially shift treatment paradigms for patients with low-stage cancers, as current protocols dictate that they might receive only primary surgery. Here we test the hypothesis that the Risk Model has added prognostic value for low-stage oral cavity squamous cell carcinoma (OCSCC) patients. 299 patients with Stage I/II OCSCC were characterized according to the Risk Model (Brandwein-Gensler et al. in Am J Surg Pathol 20:167–178, 2005; Am J Surg Pathol 34:676–688, 2010). Cumulative incidence and competing risk analysis were performed for locoregional recurrence (LRR) and disease-specific survival (DSS). Receiver operating characteristic analyses were performed for worst pattern of invasion (WPOI) and the risk categories. 292 patients were analyzed; 30 T1N0 patients (17 %) and 26 T2N0 patients (23 %) developed LRR. Disease-specific mortality occurred in 9 T1N0 patients (6 %) and 9 T2N0 patients (10 %). On multivariable analysis, the Risk Model was significantly predictive of LRR (p = 0.0012, HR 2.41, 95 % CI 1.42, 4.11) and DSS (p = 0.0005, HR 9.16, 95 % CI 2.65, 31.66) adjusted for potential confounders. WPOI alone was also significantly predictive for LRR adjusted for potential confounders with a cut-point of either WPOI-4 (p = 0.0029, HR 3.63, 95 % CI 1.56, 8.47) or WPOI-5 (p = 0.0008, HR 2.55, 95 % CI 1.48, 4.41) and for DSS (cut point WPOI-5, p = 0.0001, HR 6.34, 95 % CI 2.50, 16.09). Given a WPOI-5, the probability of developing locoregional recurrence is 42 %. Given a high-risk classification for a combination of features other than WPOI-5, the probability of developing locoregional recurrence is 32 %. The Risk Model is the first validated model that is significantly predictive for the important niche group of low-stage OCSCC patients.

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Acknowledgments

We thank the following surgeons: Mark DeLacure MD, David Myssiorek MD, and Kepal Patel MD, from New York University Langone Medical Center, and Rick Nason MD from University of Manitoba, Cancer Care Manitoba, Winnipeg, Canada for access to their patient medical records. We also thank Cathy Sarta, RN, for meticulous patient follow-up for the Montefiore Medical Center/Albert Einstein College of Medicine cohort.

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Authors and Affiliations

  1. Departments of Pathology and Surgery, University of Alabama at Birmingham, 3545 North Pavilion, 619 19th Street South, Birmingham, AL, 35249-7331, USA

    Margaret Brandwein-Gensler

  2. The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel Aviv, Israel

    Dan Dayan & Marilena Vered

  3. The Tom Baker Cancer Centre, Calgary, AB, Canada

    Joseph C. Dort & Harold Lau

  4. Department of Surgery, New York University Langone Medical Center, New York, NY, USA

    Keith Heller

  5. Departments of Pathology and Surgery, Continuum Health Partners Beth Israel Medical Center, New York, NY, USA

    George Jour & Bruce Wenig

  6. Department of Pathology, University of Manitoba, Cancer Care Manitoba, Winnipeg, Canada

    Carla Penner

  7. Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Michael Prystowsky

  8. Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 6441717 11th Avenue South, Birmingham, AL, 35205, USA

    Yufeng Li

  9. Department of Surgery, Section of Head and Neck Oncology, University of Alabama at Birmingham, BDB 563 1530 3rd Ave South, Birmingham, AL, 35294-0012, USA

    William Carroll

  10. Department of Otorhinolaryngology Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Richard V. Smith

  11. Department of Surgery, Continuum Health Partners Beth Israel Medical Center, New York, NY, USA

    Mark Urken

  12. Departments of Epidemiology and Population Health, and Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Nicolas F. Schlecht & Abdissa Negassa

  13. Department of Pathology, University of Alabama at Birmingham, 3545 North Pavilion, 619 19th Street South, Birmingham, AL, 35249-7331, USA

    Shuting Bai

  14. Department of Pathology, New York University Langone Medical Center, New York, NY, USA

    Beverly Wang

  15. Department of Surgery, Division of Otolaryngology, University of Alabama at Birmingham, BDB 563 1530 3rd Ave South, Birmingham, AL, 35249-7331, USA

    Eben Rosenthal

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  1. Yufeng Li
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  2. Shuting Bai
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  3. William Carroll
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  15. Marilena Vered
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  16. Beverly Wang
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  18. Abdissa Negassa
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  19. Margaret Brandwein-Gensler
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Corresponding author

Correspondence to Margaret Brandwein-Gensler.

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Both Drs. Negassa and Brandwein-Gensler are the senior authors.

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Li, Y., Bai, S., Carroll, W. et al. Validation of the Risk Model: High-Risk Classification and Tumor Pattern of Invasion Predict Outcome for Patients with Low-Stage Oral Cavity Squamous Cell Carcinoma. Head and Neck Pathol 7, 211–223 (2013). https://doi.org/10.1007/s12105-012-0412-1

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  • DOI: https://doi.org/10.1007/s12105-012-0412-1

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