The impact of nodal status in major salivary gland carcinoma: a multicenter experience and proposal of a novel N-classification

Davide Lombardi, Michele Tomasoni, Alberto Paderno, Davide Mattavelli, Marco Ferrari, Simonetta Battocchio, Francesco Missale, Francesco Mazzola, Giorgio Peretti, Davide Mocellin, Daniele Borsetto, Jonathan M Fussey, Paul Nankivell, Nikoleta Skalidi, Mario Bussi, Leone Giordano, Andrea Galli, Gianluigi Arrigoni, Elena Raffetti, Paul PracyVincent Vander Poorten, Piero Nicolai

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Article number105076
JournalOral Oncology
Volume112
Early online date30 Oct 2020
DOIs
Publication statusPublished - Jan 2021

Bibliographical note

Publisher Copyright:
© 2020

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

  • Extra-nodal extension
  • Head and neck cancer
  • Major salivary gland cancer
  • Nodal metastasis
  • Parotid gland
  • Parotid lymph-nodes
  • Positive lymph-node diameter
  • Positive lymph-node number
  • Submandibular gland
  • Tumor staging

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research

Fingerprint

Dive into the research topics of 'The impact of nodal status in major salivary gland carcinoma: a multicenter experience and proposal of a novel N-classification'. Together they form a unique fingerprint.

Cite this