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Clinical Nodal Stage is a Significant Predictor of Outcome in Patients with Oral Cavity Squamous Cell Carcinoma and Pathologically Negative Neck Metastases: Results of the International Consortium for Outcome Research

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We aimed to study the importance of clinical N classification (cN) in a subgroup of patients with oral cavity squamous cell carcinoma (OSCC) and pathologically negative neck nodes (pN−).

Methods

A total of 2,258 patients from 11 cancer centers who underwent neck dissection for OSCC (1990–2011) had pN− disease. The median follow-up was 44 months. 5-year overall survival (OS), disease-specific survival (DSS), disease free survival, local control, locoregional control, and distant metastasis rates were calculated by the Kaplan–Meier method. cN classification and tumor, node, metastasis classification system staging variables were subjected to multivariate analysis.

Results

A total of 345 patients were preoperatively classified as cN+ and 1,913 were classified as cN−. The 5-year OS and DSS of cN− patients were 73.6 and 82.2 %, respectively. The 5-year OS and DSS of cN+ patients were 64.9 and 76.9 %, respectively (p < 0.0001 each). A cN+ classification was a significant predictor of worse OS (p = 0.03) and DSS (p = 0.016), regardless of treatment, depth of invasion, or extent of neck dissection. cN classification was associated with recurrence-free survival (p = 0.01) and locoregional (neck and primary tumor) control (p = 0.004), but not with local (p = 0.19) and distant (p = 0.06) recurrence rates.

Conclusions

Clinical evidence of neck metastases is an independent predictor of outcome, even in patients with pN− nodes.

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Acknowledgment

This research was supported by the Israel Science Foundation, the Israel Cancer Association (Grant donated by Ellen and Emanuel Kronitz in memory of Dr. Leon Kronitz; Grant 20090068), the Israeli Ministry of Health (Grant 3-7355), the Weizmann Institute—TASMC Joint Grant, the ICRF Barbara S. Goodman endowed research career development award (Grant 2011-601-BGPC), an Intramural Grant from Rambam Medical Center, and a grant from the U.S.–Israel Binational Science Foundation. Esther Eshkol is thanked for her editorial assistance. We would like to thank Dr. Ester Shabtai and Carmit Rubin, MA, Statistics Services Unit, Tel Aviv, Sourasky Medical Center, Tel Aviv, Israel, for the statistical analysis.

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The authors declare no conflict of interest.

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Correspondence to Ziv Gil MD, PhD.

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10434_2013_3044_MOESM1_ESM.bmp

Supplemental figure 1. The impact of adjuvant chemotherapy on outcome in cN+/pN- patients. (A) Five-year overall survival and (B) disease-specific survival calculated using the Kaplan-Meier analysis in patients with clinically positive neck nodes and pathologically negative neck nodes. CRT adjuvant chemoradiation therapy (red line), RT adjuvant radiotherapy (blue line). (BMP 675 kb)

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Amit, M., Yen, T.C., Liao, C.T. et al. Clinical Nodal Stage is a Significant Predictor of Outcome in Patients with Oral Cavity Squamous Cell Carcinoma and Pathologically Negative Neck Metastases: Results of the International Consortium for Outcome Research. Ann Surg Oncol 20, 3575–3581 (2013). https://doi.org/10.1245/s10434-013-3044-0

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  • DOI: https://doi.org/10.1245/s10434-013-3044-0

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