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Nodal characteristics associated with adverse prognosis in oral cavity cancer are linked to host immune status
Author(s) -
Valero Cristina,
Zai Daniella K.,
Pillai Anjali,
Xu Bin,
Katabi Nora,
Ghossein Ronald A.,
Ganly Ian,
Morris Luc G. T.,
Shah Jatin P.,
Wong Richard J.,
Patel Snehal G.
Publication year - 2021
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26235
Subject(s) - medicine , hazard ratio , oncology , lymph node , nodal , neck dissection , cancer , neutrophil to lymphocyte ratio , cohort , retrospective cohort study , lymphocyte , confidence interval
Background and Objective Nodal metastasis is one of the strongest predictors of outcomes in oral cavity squamous cell carcinomas (OSCC). The aim was to analyze the interplay of nodal characteristics in OSCC prognosis. Methods In this retrospective cohort study we included OSCC patients treated with primary surgery including neck dissection between 2005 and 2015 ( n = 619). Disease‐specific survival (DSS) was the primary endpoint. Optimal cutoffs were identified using recursive‐partitioning analysis (RPA). A novel characteristic—metastatic focus‐to‐lymph node size ratio (MLR)—was introduced. We compared the American Joint Committee on Cancer, Eighth Edition (AJCC8) pN categories to a new categorization. Results Patients with higher neutrophil‐to‐lymphocyte ratio had more adverse nodal characteristics. All nodal characteristics were significant predictors of DSS in univariable analysis. In multivariable analysis, only number of positive nodes and MLR remained significant. An RPA including all nodal covariates confirmed the results. Compared with AJCC8, our RPA categorization had better hazard discrimination (0.681 vs. 0.598), but poorer balance value (0.783 vs. 0.708). Conclusion Patients with higher neutrophil‐to‐lymphocyte ratio had more adverse nodal characteristics. Total number of metastatic lymph nodes is the strongest predictor of outcomes in OSCC. MLR is a more powerful predictor than metastatic lymph node size or metastatic focus size alone.