title: Prognostic Performance of Current Stage III Oral Cancer Patients After Curative Intent Resection: Evidence to Support a Revision of the American Joint Committee on Cancer Staging System.
abstract: BACKGROUND
  The American Joint Committee on Cancer (AJCC) stage III classification of oral cavity squamous cell carcinoma (OCSCC) represents a heterogeneous group of patients with early local disease with regional metastases (T1N1 and T2N1) and advanced local disease with or without regional metastasis (T3N0 and T3N1).
  
  
  OBJECTIVE
  The aim of this study was to evaluate prognostic heterogeneity in the stage III category.
  
  
  METHODS
  An international retrospective multicenter study of 1815 patients who were treated for OCSCC from 2003 to 2011.
  
  
  RESULTS
  Kaplan-Meier survival analysis and multivariate models of stage III patients revealed better overall survival (OS; HR 2.12, 95 % CI 1.03-4.15; p = 0.01) and disease-specific survival (DSS; HR 1.7, 95 % CI 1.16-4.12; p = 0.04) rates for patients with T1-2N1/T3N0 disease than for patients with T3N1 disease. The outcomes of patients with T3N1 and stage IVa disease were similar (p = 0.89 and p = 0.78 for OS and DSS, respectively). Modifying stage classification by transferring the T3N1 category to the stage VIa group resulted in a better prognostic performance [Harrell's concordance index, C index 0.76; Akaike's Information Criterion (AIC) 4131.6] compared with the AJCC 7th edition staging system (C index 0.65; AIC 4144.9) for OS. When DSS was assessed, the suggested staging system remained the best performing model (C index 0.71; AIC 1061.3) compared with the current AJCC 7th edition staging (C index 0.64; AIC 1066.2).
  
  
  CONCLUSIONS
  The prognosis of T3N1 and stage IVa disease are similar in OCSCC, suggesting that these categories could be combined in future revisions of the nodal staging system to enhance prognostic accuracy.
authors: The Laboratory for Applied Cancer Research, Clinical Research Institute at Rambam, Rappaport Institute for Research in Medical Science, Haifa, Israel.|Department of Otolaryngology, Head and Neck Surgery, Head and Neck Center, Rambam Medical Center, Rappaport School of Medicine, The Technion, Israel Institute of Technology, 66036, Haifa, Israel.
authors: M
authors: M
authors: Amit
authors: Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors: T C
authors: TC
authors: Yen
authors: Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors: C T
authors: CT
authors: Liao
authors: Tata Memorial Hospital, Mumbai, India.
authors: P
authors: P
authors: Chaturvedi
authors: Tata Memorial Hospital, Mumbai, India.
authors: J P
authors: JP
authors: Agarwal
authors: A.C. Camargo Cancer Center, São Paulo, Brazil.
authors: L P
authors: LP
authors: Kowalski
authors: A.C. Camargo Cancer Center, São Paulo, Brazil.
authors: Hugo F
authors: HF
authors: Kohler
authors: Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, Australia.|Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
authors: A
authors: A
authors: Ebrahimi
authors: Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, Australia.
authors: J R
authors: JR
authors: Clark
authors: Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil.
authors: C R
authors: CR
authors: Cernea
authors: Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil.
authors: S J
authors: SJ
authors: Brandao
authors: Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany.
authors: M
authors: M
authors: Kreppel
authors: Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany.
authors: J
authors: J
authors: Zöller
authors: Department of Pathology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors: M D
authors: MD
authors: Fliss
authors: Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel.
authors: G
authors: G
authors: Bachar
authors: Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel.
authors: T
authors: T
authors: Shpitzer
authors: Department of ENT, University of Brescia, Owensboro, Italy.
authors: V A
authors: VA
authors: Bolzoni
authors: University of Auckland, Auckland, New Zealand.
authors: P R
authors: PR
authors: Patel
authors: Southern Illinois University School of Medicine, Springfield, IL, USA.
authors: S
authors: S
authors: Jonnalagadda
authors: Southern Illinois University School of Medicine, Springfield, IL, USA.
authors: K T
authors: KT
authors: Robbins
authors: Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre Singapore, Singapore, Singapore.
authors: N G
authors: NG
authors: Iyer
authors: Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre Singapore, Singapore, Singapore.
authors: T
authors: T
authors: Skanthakumar
authors: Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: J P
authors: JP
authors: Shah
authors: Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: S G
authors: SG
authors: Patel
authors: The Laboratory for Applied Cancer Research, Clinical Research Institute at Rambam, Rappaport Institute for Research in Medical Science, Haifa, Israel. moranamit@gmail.com.|Department of Otolaryngology, Head and Neck Surgery, Head and Neck Center, Rambam Medical Center, Rappaport School of Medicine, The Technion, Israel Institute of Technology, 66036, Haifa, Israel. moranamit@gmail.com.
authors: Z
authors: Z
authors: Gil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007390:International Agencies; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology* / Q000601:surgery; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000592:standards*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States; D055815:Young Adult