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Variations in the association of grade with survival across the head and neck cancer landscape
Author(s) -
Anderson Eric M.,
Luu Michael,
Balzer Bonnie L.,
Scher Kevin S.,
Mita Alain C.,
Lu Diana J.,
Shiao Stephen L.,
Clair Jon MallenSt.,
Ho Allen S.,
Zumsteg Zachary S.
Publication year - 2021
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.26566
Subject(s) - medicine , lymphovascular invasion , head and neck cancer , oncology , proportional hazards model , cancer , head and neck squamous cell carcinoma , hazard ratio , larynx , surgery , confidence interval , metastasis
Background Although pathologic tumor grade is a well‐established prognostic risk factor that impacts staging and treatment decisions across multiple cancer types, its role in head and neck squamous cell carcinoma (HNSCC) is less certain. Methods HNSCC patients diagnosed from 2010 to 2015 and undergoing primary surgery in the National Cancer Data Base were identified. Propensity score matching and multivariable Cox regression were performed. Results Among 27 041 HNSCC patients, 13 941 had oral cavity cancers (OCC). Intermediate‐grade (hazard ratio [HR] 1.16, 95% CI 1.07‐1.26, P < .001) and high‐grade (HR 1.38, 95% CI 1.26‐1.52, P < .001) tumors had worse survival than low‐grade tumors. This magnitude was comparable to other well‐established prognostic factors, including margin positivity, extranodal extension, and lymphovascular invasion. By contrast, there was no association between grade and survival in larynx/hypopharynx or HPV(−) oropharynx cancer. Conclusions The prognostic impact of pathologic grade is highly variable across head and neck subsites and is the strongest among OCC patients.