title: 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.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.|University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Ardalan
authors.initials: A
authors.lastname: Ebrahimi
authors.affiliation: The Laboratory for Applied Cancer Research, the Technion, Israel Institute of Technology, Haifa, Israel.|Department of Otolaryngology, Rambam Medical Center, Rappaport School of Medicine, the Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Ziv
authors.initials: Z
authors.lastname: Gil
authors.affiliation: The Laboratory for Applied Cancer Research, the Technion, Israel Institute of Technology, Haifa, Israel.|Department of Otolaryngology, Rambam Medical Center, Rappaport School of Medicine, the Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Moran
authors.initials: M
authors.lastname: Amit
authors.affiliation: Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yen
authors.affiliation: Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Liao
authors.affiliation: Tata Memorial Hospital, Mumbai, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Chatturvedi
authors.affiliation: Tata Memorial Hospital, Mumbai, India.
authors.forename: Jaiprakash
authors.initials: J
authors.lastname: Agarwal
authors.affiliation: Hospital A.C. Camargo, São Paulo, Brazil.
authors.forename: Luiz
authors.initials: L
authors.lastname: Kowalski
authors.affiliation: Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kreppel
authors.affiliation: Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cernea
authors.affiliation: Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Jose
authors.initials: J
authors.lastname: Brandao
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel.
authors.forename: Gideon
authors.initials: G
authors.lastname: Bachar
authors.affiliation: Department of ENT, University of Brescia, Brescia, Italy.
authors.forename: Andrea Bolzoni
authors.initials: AB
authors.lastname: Villaret
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Fliss
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Fridman
authors.affiliation: Southern Illinois University School of Medicine, Carbondale, Illinois.
authors.forename: K Thomas
authors.initials: KT
authors.lastname: Robbins
authors.affiliation: Head and Neck Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Jatin
authors.initials: J
authors.lastname: Shah
authors.affiliation: Head and Neck Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Snehal
authors.initials: S
authors.lastname: Patel
authors.affiliation: Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Clark
mesh_terms: D000368:Aged; D001315:Australia; D001938:Brazil; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007194:India; D007557:Israel; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D013624:Taiwan; D014481:United States
keywords: cancer staging; head and neck neoplasms; lymph node metastases; oral squamous cell carcinoma; prognosis