TY - JOUR
T1 - The impact of nodal status in major salivary gland carcinoma
T2 - a multicenter experience and proposal of a novel N-classification
AU - Lombardi, Davide
AU - Tomasoni, Michele
AU - Paderno, Alberto
AU - Mattavelli, Davide
AU - Ferrari, Marco
AU - Battocchio, Simonetta
AU - Missale, Francesco
AU - Mazzola, Francesco
AU - Peretti, Giorgio
AU - Mocellin, Davide
AU - Borsetto, Daniele
AU - Fussey, Jonathan M
AU - Nankivell, Paul
AU - Skalidi, Nikoleta
AU - Bussi, Mario
AU - Giordano, Leone
AU - Galli, Andrea
AU - Arrigoni, Gianluigi
AU - Raffetti, Elena
AU - Pracy, Paul
AU - Vander Poorten, Vincent
AU - Nicolai, Piero
N1 - Publisher Copyright:
© 2020
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Objectives: Despite differences in oncological behavior, the 8th edition of AJCC TNM staging currently proposes the same N-classification for major salivary glands (MSG) carcinoma and squamous cell carcinoma of the upper aerodigestive tract. The present study aims to investigate a more reliable definition of N-categories for MSG carcinoma. Materials and methods: A retrospective multicenter study was performed, including 307 patients treated for primary MSG carcinoma from 1995 to 2019. Outcome measures included overall survival (OS), disease specific survival, and local, regional, and distant recurrence. Survival analysis was performed using log-rank test and Cox proportional-hazards model. Overall number (ON) and largest diameter (LD) of nodal metastases, including intra-parotid metastases, were considered to develop three novel proposals of N-classification; their performance were compared with the current TNM staging using Akaike information criterion (AIC), Bayesian information criterion (BIC), and Nagelkerke pseudo-R 2. Results: Intra-parotid nodes, ON and LD of nodal metastases emerged as major prognosticators for OS, while extra-nodal extension did not impact on any survival. The current N-classification did not show a satisfactory OS stratification. Three novel N-classifications were developed according to number of metastatic nodes (0 vs 1–3 vs ≥ 4) and/or their maximum diameter (<20 mm vs ≥ 20 mm). They all showed better accuracy in OS stratification, and achieved better AIC, BIC and Nagelkerke pseudo-R 2 indices when compared to current N-classification. Conclusion: All the proposed N-classifications improved OS stratification and could help in defining a specific N-classification for MSG carcinoma. Their validation and assessment in an external cohort is needed.
AB - Objectives: Despite differences in oncological behavior, the 8th edition of AJCC TNM staging currently proposes the same N-classification for major salivary glands (MSG) carcinoma and squamous cell carcinoma of the upper aerodigestive tract. The present study aims to investigate a more reliable definition of N-categories for MSG carcinoma. Materials and methods: A retrospective multicenter study was performed, including 307 patients treated for primary MSG carcinoma from 1995 to 2019. Outcome measures included overall survival (OS), disease specific survival, and local, regional, and distant recurrence. Survival analysis was performed using log-rank test and Cox proportional-hazards model. Overall number (ON) and largest diameter (LD) of nodal metastases, including intra-parotid metastases, were considered to develop three novel proposals of N-classification; their performance were compared with the current TNM staging using Akaike information criterion (AIC), Bayesian information criterion (BIC), and Nagelkerke pseudo-R 2. Results: Intra-parotid nodes, ON and LD of nodal metastases emerged as major prognosticators for OS, while extra-nodal extension did not impact on any survival. The current N-classification did not show a satisfactory OS stratification. Three novel N-classifications were developed according to number of metastatic nodes (0 vs 1–3 vs ≥ 4) and/or their maximum diameter (<20 mm vs ≥ 20 mm). They all showed better accuracy in OS stratification, and achieved better AIC, BIC and Nagelkerke pseudo-R 2 indices when compared to current N-classification. Conclusion: All the proposed N-classifications improved OS stratification and could help in defining a specific N-classification for MSG carcinoma. Their validation and assessment in an external cohort is needed.
KW - Extra-nodal extension
KW - Head and neck cancer
KW - Major salivary gland cancer
KW - Nodal metastasis
KW - Parotid gland
KW - Parotid lymph-nodes
KW - Positive lymph-node diameter
KW - Positive lymph-node number
KW - Submandibular gland
KW - Tumor staging
UR - http://www.scopus.com/inward/record.url?scp=85094213025&partnerID=8YFLogxK
U2 - 10.1016/j.oraloncology.2020.105076
DO - 10.1016/j.oraloncology.2020.105076
M3 - Article
C2 - 33137587
SN - 1368-8375
VL - 112
JO - Oral Oncology
JF - Oral Oncology
M1 - 105076
ER -