Aims

In the current eighth edition head and neck TNM staging, extranodal extension (ENE) is an adverse feature in oral cavity squamous cell cancer (OSCC). The previous seventh edition N1 with ENE is now staged as N2a. Seventh edition N2+ with ENE is staged as N3b in the eighth edition. We evaluated its potential impact on patients treated with surgery and postoperative intensity-modulated radiotherapy (IMRT).

Materials and methods

OSCC patients treated with primary surgery and adjuvant (chemo)radiotherapy between January 2005 and December 2014 were reviewed. Cohorts with pathological node-negative (pN–), pathological node-positive without ENE (pN+_pENE–) and pathological node-positive with ENE (pN+_pENE+) diseases were compared for local control, regional control, distant control and overall survival. The pN+ cohorts were further stratified into seventh edition N-staging subgroups for outcomes comparison.

Results

In total, 478 patients were evaluated: 173 pN–; 159 pN+_pENE–; 146 pN+_pENE+. Outcomes at 5 years were: local control was identical (78%) in all cohorts (P = 0.892), whereas regional control was 91%, 80% and 68%, respectively (P < 0.001). Distant control was 97%, 87%, 68% (P < 0.001) and overall survival was 75%, 53% and 39% (P < 0.001), respectively. Overall survival for N1 and N2a subgroups was not significantly different. In the seventh edition N2b subgroup of pENE– (n = 79) and pENE+ (n = 79) cohorts, overall survival was 67% and 37%, respectively. In the seventh edition N2c subgroups, overall survival for pENE– (n = 17) and pENE+ (n = 38) cohorts was 65% and 35% (P = 0.08), respectively. Overall, an additional 128 patients (42% pN+) were upstaged as N3b.

Conclusions

When eighth edition staging was applied, stage migration across the N2–3 categories resulted in expected larger separations of overall survival by stage. Patients treated with primary radiation without surgical staging should have outcomes carefully monitored. Strategies to predict ENE preoperatively and trials to improve the outcomes of pENE+ patients should be explored.

中文翻译：

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第八版 TNM 分期分类对口腔癌的潜在影响和可用性

宗旨

在目前的第八版头颈部 TNM 分期中，结外扩展 (ENE) 是口腔鳞状细胞癌 (OSCC) 的不利特征。以前的带有 ENE 的第七版 N1 现在升级为 N2a。带有 ENE 的第七版 N2+ 在第八版中被列为 N3b。我们评估了其对接受手术和术后调强放疗 (IMRT) 治疗的患者的潜在影响。

材料和方法

回顾了 2005 年 1 月至 2014 年 12 月期间接受初次手术和辅助（化学）放射治疗的 OSCC 患者。比较了病理淋巴结阴性 (pN-)、病理淋巴结阳性无 ENE (pN+_pENE-) 和病理淋巴结阳性伴有 ENE (pN+_pENE+) 疾病的队列的局部控制、区域控制、远程控制和总生存期. pN+ 队列进一步分层为第七版 N 分期亚组以进行结果比较。

结果

总共评估了 478 名患者：173 pN-；第159话 146 pN+_pENE+。5 年的结果是：所有队列的局部控制率相同 (78%) ( P = 0.892)，而区域控制率分别为 91%、80% 和 68% ( P < 0.001)。远处控制率分别为 97%、87%、68% ( P < 0.001)，总生存率分别为 75%、53% 和 39% ( P < 0.001)。N1 和 N2a 亚组的总生存期没有显着差异。在 pENE–（n = 79）和 pENE+（n = 79）队列的第七版 N2b 亚组中，总生存率分别为 67% 和 37%。在第七版 N2c 亚组中，pENE– ( n = 17) 和 pENE+ ( n= 38) 队列分别为 65% 和 35% ( P = 0.08)。总体而言，另外 128 名患者（42% pN+）被升级为 N3b。

结论

当应用第八版分期时，跨 N2-3 类别的分期迁移导致预期的分期总生存期有更大的分离。未经手术分期接受初次放疗的患者应仔细监测结果。应探索术前预测 ENE 的策略和改善 pENE+ 患者预后的试验。