title: Validation of the risk model: high-risk classification and tumor pattern of invasion predict outcome for patients with low-stage oral cavity squamous cell carcinoma.
abstract: The risk model is a validated outcome predictor for patients with head and neck squamous cell carcinoma (Brandwein-Gensler et al. in Am j surg pathol 20:167-178, 2005; Am J Surg Pathol 34:676-688, 2010). This model may potentially shift treatment paradigms for patients with low-stage cancers, as current protocols dictate that they might receive only primary surgery. Here we test the hypothesis that the Risk Model has added prognostic value for low-stage oral cavity squamous cell carcinoma (OCSCC) patients. 299 patients with Stage I/II OCSCC were characterized according to the risk model (Brandwein-Gensler et al. in Am J Surg Pathol 20:167-178, 2005; Am J Surg Pathol 34:676-688, 2010). Cumulative incidence and competing risk analysis were performed for locoregional recurrence (LRR) and disease-specific survival (DSS). Receiver operating characteristic analyses were performed for worst pattern of invasion (WPOI) and the risk categories. 292 patients were analyzed; 30 T1N0 patients (17%) and 26 T2N0 patients (23%) developed LRR. Disease-specific mortality occurred in 9 T1N0 patients (6%) and 9 T2N0 patients (10%). On multivariable analysis, the risk model was significantly predictive of LRR (p = 0.0012, HR 2.41, 95% CI 1.42, 4.11) and DSS (p = 0.0005, HR 9.16, 95% CI 2.65, 31.66) adjusted for potential confounders. WPOI alone was also significantly predictive for LRR adjusted for potential confounders with a cut-point of either WPOI-4 (p = 0.0029, HR 3.63, 95% CI 1.56, 8.47) or WPOI-5 (p = 0.0008, HR 2.55, 95% CI 1.48, 4.41) and for DSS (cut point WPOI-5, p = 0.0001, HR 6.34, 95% CI 2.50, 16.09). Given a WPOI-5, the probability of developing locoregional recurrence is 42%. Given a high-risk classification for a combination of features other than WPOI-5, the probability of developing locoregional recurrence is 32%. The Risk Model is the first validated model that is significantly predictive for the important niche group of low-stage OCSCC patients.
authors.affiliation: Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 6441717 11th Avenue South, Birmingham, AL 35205, USA.
authors.forename: Yufeng
authors.initials: Y
authors.lastname: Li
authors.forename: Shuting
authors.initials: S
authors.lastname: Bai
authors.forename: William
authors.initials: W
authors.lastname: Carroll
authors.forename: Dan
authors.initials: D
authors.lastname: Dayan
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Dort
authors.forename: Keith
authors.initials: K
authors.lastname: Heller
authors.forename: George
authors.initials: G
authors.lastname: Jour
authors.forename: Harold
authors.initials: H
authors.lastname: Lau
authors.forename: Carla
authors.initials: C
authors.lastname: Penner
authors.forename: Michael
authors.initials: M
authors.lastname: Prystowsky
authors.forename: Eben
authors.initials: E
authors.lastname: Rosenthal
authors.forename: Nicolas F
authors.initials: NF
authors.lastname: Schlecht
authors.forename: Richard V
authors.initials: RV
authors.lastname: Smith
authors.forename: Mark
authors.initials: M
authors.lastname: Urken
authors.forename: Marilena
authors.initials: M
authors.lastname: Vered
authors.forename: Beverly
authors.initials: B
authors.lastname: Wang
authors.forename: Bruce
authors.initials: B
authors.lastname: Wenig
authors.forename: Abdissa
authors.initials: A
authors.lastname: Negassa
authors.forename: Margaret
authors.initials: M
authors.lastname: Brandwein-Gensler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002294:Carcinoma, Squamous Cell / Q000145:classification* / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009062:Mouth Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D012372:ROC Curve; D012306:Risk; D016896:Treatment Outcome