Effect of extranodal extension on TNM staging and survival in patients with oral squamous cell carcinoma

doi:10.19438/j.cjoms.2023.04.010

Abstract

Abstract: PURPOSE: By analyzing the influence of extranodal extension (ENE) on TNM staging manual and survival after included into the staging, to learn about the significance of ENE on clinical decision-making and prognosis of oral cancer. METHODS: A retrospective cohort study of 485 patients with primary oral squamous cell carcinoma(OSCC) from January 2014 to June 2017 was performed in the Affiliated Hospital of Qingdao University. The AJCC 7th and 8th edition staging systems was applied to the patients. Overall survival and disease-specific survival were analyzed by Kaplan-Meier analysis and Log-rank test with SPSS 26.0 software package. Concordance index and Akaike information criterion(AIC) was used to evaluate the system’s prognostic capacity. RESULTS: A total of 485 patients with OSCC were followed up. The pathological N stage of 69 (14.43%) patients (including 16 pN2a and 53 pN3b) was changed by extranodal extension. The pathological TNM stage of 67(13.81%) patients (including 14 ⅣA and 53 ⅣB) was also changed because of ENE. Overall survival and disease-specific survival model analysis of N stage, TNM stage and ENE showed that patients with positive ENE (OS:27.1%, DSS:31.2%) had a lower survival rate than those with negative ENE(OS:72.2%, DSS:78.0%). AIC of AJCC 8th edition staging systems was lower than 7th edition and there was little difference between them in terms of concordance index. CONCLUSIONS: Extranodal extension changed TNM staging of OSCC patients. The number of advanced patients increased significantly and the survival prognosis became worse. ENE can objectively refect the status of the patients. It has more guiding significance for decision-making and prognosis evaluation of oral cancer patients.

Key words: Extranodal extension, Oral cancer, Oral squamous cell carcinoma, AJCC 8, TNM stage, Survival rate

CLC Number:

R739.8

LI Gui-zhong, LI Jie-ying, ZHOU Kai, MENG Yu-xiang, WANG Ke-xin, GE Sheng-you, SONG Kai, FENG Yuan-yong, TAO Yue-qin, ZHAN Xiao-hong, SHANG Wei. Effect of extranodal extension on TNM staging and survival in patients with oral squamous cell carcinoma[J]. China Journal of Oral and Maxillofacial Surgery, 2023, 21(4): 377-383.

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