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Risk stratification of oral cancer patients using a combined prognostic factor including lymph node density and biomarker

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Abstract

Purpose

In this study, we aimed to validate the lymph node density (LND) as an independent prognostic factor of oral squamous cell carcinoma (OSCC) and identify a combined prognostic factor including LND, predicting better performance in risk stratification.

Methods

We reviewed the clinical, pathological variables and biomarker of 95 OSCC patients who underwent surgery. LND was calculated as the ratio of positive lymph nodes to total lymph nodes removed. Principle component analysis was performed to identify a combined predictor.

Results

Multivariate analysis showed that variables independently prognostic overall survival were IMP3 (hazard ratio [HR] = 3.01, 95% confidence interval [95% CI] = 1.17–7.75, P = 0.022) in a model without LND and were IMP3 (HR = 3.64, 95% CI = 1.38–9.58, P = 0.008) and LND (HR = 0.57, 95% CI = 0.57–1.75, P = 0.322; HR = 2.45, 95% CI = 1.20–4.97, P = 0.013) in a model with LND. The risk stratification using the combined prognostic factor was more significant (P = 0.00117) than the conventional staging system and biomarker.

Conclusions

The LND was shown to be an independent prognostic factor in OSCC, and a combined factor including LND may be used for risk stratification of OSCC patients, which displayed the best performance.

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References

  • Aprill C, Dwyer A, Bogduk N (1990) Cervical zygapophyseal joint pain patterns II: a clinical evaluation. Spine (Phila Pa 1976) 15:458–461

    Article  CAS  Google Scholar 

  • Berger AC, Fierro M, Kairys JC, Berd D, Sato T, Andrel J, Hyslop T, Mastrangelo MJ (2011) Lymph node ratio is an important and independent prognostic factor for patients with stage III melanoma. J Surg Oncol. doi:10.1002/jso.22051

  • Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefebvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945–1952. doi:10.1056/NEJMoa032641

    Article  PubMed  CAS  Google Scholar 

  • Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, Ozsahin EM, Jacobs JR, Jassem J, Ang KK, Lefebvre JL (2005) Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 27:843–850. doi:10.1002/hed.20279

    Article  PubMed  Google Scholar 

  • Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350:1937–1944. doi:10.1056/NEJMoa032646

    Article  PubMed  Google Scholar 

  • Ebrahimi A, Clark JR, Zhang WJ, Elliott MS, Gao K, Milross CG, Shannon KF (2011) Lymph node ratio as an independent prognostic factor in oral squamous cell carcinoma. Head Neck 33:1245–1251. doi:10.1002/hed.21600

    Article  PubMed  Google Scholar 

  • Fukunaga K (1990) Introduction to statistical pattern recognition. Academic Press, Boston

    Google Scholar 

  • Gavilan J, Prim MP, De Diego JI, Hardisson D, Pozuelo A (2000) Postoperative radiotherapy in patients with positive nodes after functional neck dissection. Ann Otol Rhinol Laryngol 109:844–848

    PubMed  CAS  Google Scholar 

  • Gil Z, Carlson DL, Boyle JO, Kraus DH, Shah JP, Shaha AR, Singh B, Wong RJ, Patel SG (2009) Lymph node density is a significant predictor of outcome in patients with oral cancer. Cancer 115:5700–5710. doi:10.1002/cncr.24631

    Article  PubMed  Google Scholar 

  • Herr HW (2003) Superiority of ratio based lymph node staging for bladder cancer. J Urol 169:943–945. doi:10.1097/01.ju.0000032474.22093.06

    Article  PubMed  Google Scholar 

  • Herr HW (2007) The concept of lymph node density–is it ready for clinical practice? J Urol 177:1273–1275; discussion 1275–1276. doi:10.1016/j.juro.2006.11.094

    Google Scholar 

  • Kassouf W, Leibovici D, Munsell MF, Dinney CP, Grossman HB, Kamat AM (2006) Evaluation of the relevance of lymph node density in a contemporary series of patients undergoing radical cystectomy. J Urol 176:53–57; discussion 57. doi:10.1016/S0022-5347(06)00510-6

    Google Scholar 

  • Kassouf W, Agarwal PK, Herr HW, Munsell MF, Spiess PE, Brown GA, Pisters L, Grossman HB, Dinney CP, Kamat AM (2008) Lymph node density is superior to TNM nodal status in predicting disease-specific survival after radical cystectomy for bladder cancer: analysis of pooled data from MDACC and MSKCC. J Clin Oncol 26:121–126. doi:10.1200/JCO.2007.12.9247

    Article  PubMed  Google Scholar 

  • Kim SY, Nam SY, Choi SH, Cho KJ, Roh JL (2011) Prognostic value of lymph node density in node-positive patients with oral squamous cell carcinoma. Ann Surg Oncol 18:2310–2317. doi:10.1245/s10434-011-1614-6

    Article  PubMed  Google Scholar 

  • Konety BR, Joslyn SA, O’Donnell MA (2003) Extent of pelvic lymphadenectomy and its impact on outcome in patients diagnosed with bladder cancer: analysis of data from the Surveillance, Epidemiology and End Results Program data base. J Urol 169:946–950. doi:10.1097/01.ju.0000052721.61645.a3

    Article  PubMed  Google Scholar 

  • Li S, Cha J, Kim J, Kim KY, Kim HJ, Nam W, Cha IH (2011) Insulin-like growth factor II mRNA-binding protein 3: a novel prognostic biomarker for oral squamous cell carcinoma. Head Neck 33:368–374. doi:10.1002/hed.21457

    Article  PubMed  Google Scholar 

  • Margel D, Harel A, Yossepowitch O, Baniel J (2009) A novel algorithm to improve pathologic stage prediction of clinically organ-confined muscle-invasive bladder cancer. Cancer 115:1459–1464. doi:10.1002/cncr.24138

    Article  PubMed  Google Scholar 

  • Ooki A, Yamashita K, Kobayashi N, Katada N, Sakuramoto S, Kikuchi S, Watanabe M (2007) Lymph node metastasis density and growth pattern as independent prognostic factors in advanced esophageal squamous cell carcinoma. World J Surg 31:2184–2191. doi:10.1007/s00268-007-9198-9

    Article  PubMed  Google Scholar 

  • Parsons JT, Mendenhall WM, Stringer SP, Cassisi NJ, Million RR (1997) An analysis of factors influencing the outcome of postoperative irradiation for squamous cell carcinoma of the oral cavity. Int J Radiat Oncol Biol Phys 39:137–148

    PubMed  CAS  Google Scholar 

  • Rudoltz MS, Benammar A, Mohiuddin M (1995) Does pathologic node status affect local control in patients with carcinoma of the head and neck treated with radical surgery and postoperative radiotherapy? Int J Radiat Oncol Biol Phys 31:503–508

    Article  PubMed  CAS  Google Scholar 

  • Sanderson RJ, Ironside JA (2002) Squamous cell carcinomas of the head and neck. BMJ 325:822–827

    Article  PubMed  CAS  Google Scholar 

  • Shah JP (1990) Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg 160:405–409

    Article  PubMed  CAS  Google Scholar 

  • Shingaki S, Takada M, Sasai K, Bibi R, Kobayashi T, Nomura T, Saito C (2003) Impact of lymph node metastasis on the pattern of failure and survival in oral carcinomas. Am J Surg 185:278–284

    Article  PubMed  Google Scholar 

  • Shrime MG, Bachar G, Lea J, Volling C, Ma C, Gullane PJ, Gilbert RW, Irish JC, Brown DH, Goldstein DP (2009a) Nodal ratio as an independent predictor of survival in squamous cell carcinoma of the oral cavity. Head Neck 31:1482–1488. doi:10.1002/hed.21114

    Article  PubMed  Google Scholar 

  • Shrime MG, Ma C, Gullane PJ, Gilbert RW, Irish JC, Brown DH, Goldstein DP (2009b) Impact of nodal ratio on survival in squamous cell carcinoma of the oral cavity. Head Neck 31:1129–1136. doi:10.1002/hed.21073

    Article  PubMed  Google Scholar 

  • Stein JP, Cai J, Groshen S, Skinner DG (2003) Risk factors for patients with pelvic lymph node metastases following radical cystectomy with en bloc pelvic lymphadenectomy: concept of lymph node density. J Urol 170:35–41. doi:10.1097/01.ju.0000072422.69286.0e

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by Priority Research Centers Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2011-0031396).

Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to In-Ho Cha.

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Kim, KY., Cha, IH. Risk stratification of oral cancer patients using a combined prognostic factor including lymph node density and biomarker. J Cancer Res Clin Oncol 138, 483–490 (2012). https://doi.org/10.1007/s00432-011-1129-3

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  • DOI: https://doi.org/10.1007/s00432-011-1129-3

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