Comparison of the American Joint Committee on Cancer N1 versus N2a nodal categories for predicting survival and recurrence in patients with oral cancer: Time to acknowledge an arbitrary distinction and modify the system

Ardalan Ebrahimi, Ziv Gil, Moran Amit, Tzu Chen Yen, Chun Ta Liao, Pankaj Chatturvedi, Jaiprakash Agarwal, Luiz Kowalski, Matthias Kreppel, Claudio Cernea, Jose Brandao, Gideon Bachar, Andrea Bolzoni Villaret, Dan Fliss, Eran Fridman, K. Thomas Robbins, Jatin Shah, Snehal Patel, Jonathan Clark

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Background We hypothesized that pathological N1 (pN1) and N2a (pN2a) nodal disease portend a similar prognosis in patients with oral cancer. Methods An international multicenter study of 739 oral squamous cell carcinoma (SCC) patients with pN1 or pN2a stage disease was conducted. Multivariable analyses were performed using Cox proportional hazard models to compare locoregional failure, disease-specific survival (DSS), and overall survival (OS). Institutional heterogeneity was assessed using 2-stage random effects meta-analysis techniques. Results Univariate analysis revealed no difference in locoregional failure (p =.184), DSS (p =.761), or OS (p =.475). Similar results were obtained in adjusted multivariable models and no evidence of institutional heterogeneity was demonstrated. Conclusion The prognosis of pN2a and pN1 disease is similar in oral SCC suggesting these categories could be combined in future revisions of the nodal staging system to enhance prognostic accuracy. However, these results may reflect more aggressive treatment of N2a disease; hence, we caution against using these data to deintensify treatment.

Original languageEnglish (US)
Pages (from-to)135-139
Number of pages5
JournalHead and Neck
Volume38
Issue number1
DOIs
StatePublished - Jan 1 2016

Keywords

  • cancer staging
  • head and neck neoplasms
  • lymph node metastases
  • oral squamous cell carcinoma
  • prognosis

ASJC Scopus subject areas

  • Otorhinolaryngology

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