Lymph node density in oral cavity cancer: results of the International Consortium for Outcomes Research

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background:

Lymph node density (LND) has previously been reported to reliably predict recurrence risk and survival in oral cavity squamous cell carcinoma (OSCC). This multicenter international study was designed to validate the concept of LND in OSCC.

Methods:

The study included 4254 patients diagnosed as having OSCC. The median follow-up was 41 months. Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), locoregional control and distant metastasis rates were calculated using the Kaplan–Meier method. Lymph node density (number of positive lymph nodes/total number of excised lymph nodes) was subjected to multivariate analysis.

Results:

The OS was 49% for patients with LND⩽0.07 compared with 35% for patients with LND>0.07 ( P<0.001). Similarly, the DSS was 60% for patients with LND⩽0.07 compared with 41% for those with LND>0.07 ( P<0.001). Lymph node density reliably stratified patients according to their risk of failure within the individual N subgroups ( P=0.03). A modified TNM staging system based on LND ratio was consistently superior to the traditional system in estimating survival measures.

Conclusion:

This multi-institutional study validates the reliability and applicability of LND as a predictor of outcomes in OSCC. Lymph node density can potentially assist in identifying patients with poor outcomes and therefore for whom more aggressive adjuvant treatment is needed.

Related collections

Most cited references 45

Record: found
Abstract: found
Article: not found

Time-dependent ROC curves for censored survival data and a diagnostic marker.

P Heagerty, T Lumley, M. S. Pepe (2000)

ROC curves are a popular method for displaying sensitivity and specificity of a continuous diagnostic marker, X, for a binary disease variable, D. However, many disease outcomes are time dependent, D(t), and ROC curves that vary as a function of time may be more appropriate. A common example of a time-dependent variable is vital status, where D(t) = 1 if a patient has died prior to time t and zero otherwise. We propose summarizing the discrimination potential of a marker X, measured at baseline (t = 0), by calculating ROC curves for cumulative disease or death incidence by time t, which we denote as ROC(t). A typical complexity with survival data is that observations may be censored. Two ROC curve estimators are proposed that can accommodate censored data. A simple estimator is based on using the Kaplan-Meier estimator for each possible subset X > c. However, this estimator does not guarantee the necessary condition that sensitivity and specificity are monotone in X. An alternative estimator that does guarantee monotonicity is based on a nearest neighbor estimator for the bivariate distribution function of (X, T), where T represents survival time (Akritas, M. J., 1994, Annals of Statistics 22, 1299-1327). We present an example where ROC(t) is used to compare a standard and a modified flow cytometry measurement for predicting survival after detection of breast cancer and an example where the ROC(t) curve displays the impact of modifying eligibility criteria for sample size and power in HIV prevention trials.

0 comments Cited 560 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501).

Jacques Bernier, Jay Cooper, T F Pajak … (2005)

In 2004, level I evidence was established for the postoperative adjuvant treatment of patients with selected high-risk locally advanced head and neck cancers, with the publication of the results of two trials conducted in Europe (European Organization Research and Treatment of Cancer; EORTC) and the United States (Radiation Therapy Oncology Group; RTOG). Adjuvant chemotherapy-enhanced radiation therapy (CERT) was shown to be more efficacious than postoperative radiotherapy for these tumors in terms of locoregional control and disease-free survival. However, additional studies were needed to identify precisely which patients were most suitable for such intense treatment. Both studies compared the addition of concomitant relatively high doses of cisplatin (on days 1, 22, and 43) to radiotherapy vs radiotherapy alone given after surgery in patients with high-risk cancers of the oral cavity, oropharynx, larynx, or hypopharynx. A comparative analysis of the selection criteria, clinical and pathologic risk factors, and treatment outcomes was carried out using data pooled from these two trials. Extracapsular extension (ECE) and/or microscopically involved surgical margins were the only risk factors for which the impact of CERT was significant in both trials. There was also a trend in favor of CERT in the group of patients who had stage III-IV disease, perineural infiltration, vascular embolisms, and/or clinically enlarged level IV-V lymph nodes secondary to tumors arising in the oral cavity or oropharynx. Patients who had two or more histopathologically involved lymph nodes without ECE as their only risk factor did not seem to benefit from the addition of chemotherapy in this analysis. Subject to the usual caveats of retrospective subgroup analysis, our data suggest that in locally advanced head and neck cancer, microscopically involved resection margins and extracapsular spread of tumor from neck nodes are the most significant prognostic factors for poor outcome. The addition of concomitant cisplatin to postoperative radiotherapy improves outcome in patients with one or both of these risk factors who are medically fit to receive chemotherapy. (c) 2005 Wiley Periodicals, Inc.

0 comments Cited 309 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Current concepts in management of oral cancer--surgery.

Jatin P. Shah, Ziv Gil (2015)

Oral cancer is the sixth most common cancer worldwide, with a high prevalence in South Asia. Tobacco and alcohol consumption remain the most dominant etiologic factors, however HPV has been recently implicated in oral cancer. Surgery is the most well established mode of initial definitive treatment for a majority of oral cancers. The factors that affect choice of treatment are related to the tumor and the patient. Primary site, location, size, proximity to bone, and depth of infiltration are factors which influence a particular surgical approach. Tumors that approach or involve the mandible require specific understanding of the mechanism of bone involvement. This facilitates the employment of mandible sparing approaches such as marginal mandibulectomy and mandibulotomy. Reconstruction of major surgical defects in the oral cavity requires use of a free flap. The radial forearm free flap provides excellent soft tissue and lining for soft tissue defects in the oral cavity. The fibula free flap remains the choice for mandibular reconstruction. Over the course of the past thirty years there has been improvement in the overall survival of patients with oral carcinoma largely due to the improved understanding of the biology of local progression, early identification and treatment of metastatic lymph nodes in the neck, and employment of adjuvant post-operative radiotherapy or chemoradiotherapy. The role of surgery in primary squamous cell carcinomas in other sites in the head and neck has evolved with integration of multidisciplinary treatment approaches employing chemotherapy and radiotherapy either sequentially or concurrently. Thus, larynx preservation with concurrent chemoradiotherapy has become the standard of care for locally advanced carcinomas of the larynx or pharynx requiring total laryngectomy. On the other hand, for early staged tumors of the larynx and pharynx, transoral laser microsurgery has become an effective means of local control of these lesions. Advances in skull base surgery have significantly improved the survivorship of patients with malignant tumors of the paranasal sinuses approaching or involving the skull base. Surgery thus remains the mainstay of management of a majority of neoplasms arising in the head and neck area. Similarly, the role of the surgeon is essential throughout the life history of a patient with a malignant neoplasm in the head and neck area, from initial diagnosis through definitive treatment, post-treatment surveillance, management of complications, rehabilitation of the sequelae of treatment, and finally for palliation of symptoms.

0 comments Cited 199 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Br J Cancer

Journal ID (iso-abbrev): Br. J. Cancer

Title: British Journal of Cancer

Publisher: Nature Publishing Group

ISSN (Print): 0007-0920

ISSN (Electronic): 1532-1827

Publication date (Print): 15 October 2013

Publication date (Electronic): 24 September 2013

Volume: 109

Issue: 8

Pages: 2087-2095

Affiliations

[1 ]Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center , New York, NY, USA

[2 ]Department of Otolaryngology Rambam Medical Center, the Technion, Israel Institute of Technology , Haifa, Israel

[3 ]Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital , Taoyuan, Taiwan

[4 ]Department of Surgical Oncology, Head and Neck Service, Tata Memorial Hospital , New Delhi, India

[5 ]Department of Head and Neck Surgery and Otorhinolaryngology, Hospital AC Camargo , São Paulo, Brazil

[6 ]Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital , Sydney, New South Wales, Australia

[7 ]Department of Head and Neck Surgery, University of São Paulo Medical School , São Paulo, Brazil

[8 ]Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne , Germany

[9 ]Department of Otolaryngology, Head and Neck Surgery, Tel Aviv Medical Center , Tel Aviv, Israel

[10 ]Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center , Petach Tikva, Israel

[11 ]Department of ENT, University of Brescia , Brescia, Italy

[12 ]Department of Otolaryngology, Head and Neck Surgery, University of Auckland , Auckland, New Zealand

[13 ]Southern Illinois University School of Medicine , Springfield, IL, USA

[14 ]The Laboratory for Applied Cancer Research, the Technion, Israel Institute of Technology , Haifa, Israel

Author notes

[* ]E-mail: ziv@ 123456baseofskull.org

Article

Publisher Item ID: bjc2013570

DOI: 10.1038/bjc.2013.570

PMC ID: 3798966

PubMed ID: 24064974

SO-VID: 2d41109a-536f-442f-afdb-2fd0ef69b932

License:

From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/

History

Date received : 23 May 2013

Date revision received : 22 August 2013

Date accepted : 26 August 2013

Comments

Comment on this article

scite_

Cited by 44

See all cited by

Most referenced authors 1,043

See all reference authors

Lymph node density in oral cavity cancer: results of the International Consortium for Outcomes Research

Read this article at

Abstract

Background:

Methods:

Results:

Conclusion:

Related collections

Karger: Oncology

Most cited references 45

Time-dependent ROC curves for censored survival data and a diagnostic marker.

Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501).

Current concepts in management of oral cancer--surgery.

Author and article information

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 223

Cited by 44

Most referenced authors 1,043