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Tu IWH, Shannon NB, Thankappan K, Balasubramanian D, Pillai V, Shetty V, Rangappa V, Chandrasekhar NH, Kekatpure V, Kuriakose MA, Krishnamurthy A, Mitra A, Pattatheyil A, Jain P, Iyer S, Subramaniam N, Iyer NG. Risk Stratification in Oral Cancer: A Novel Approach. Front Oncol 2022; 12:836803. [PMID: 35875164 PMCID: PMC9301677 DOI: 10.3389/fonc.2022.836803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/09/2022] [Indexed: 12/14/2022] Open
Abstract
BackgroundOral squamous cell carcinoma (OSCC) is a common head and neck cancer with high morbidity and mortality. Currently, treatment decisions are guided by TNM staging, which omits important negative prognosticators such as lymphovascular invasion, perineural invasion (PNI), and histologic differentiation. We proposed nomogram models based on adverse pathological features to identify candidates suitable for treatment escalation within each risk group according to the National Comprehensive Cancer Network (NCCN) guidelines.MethodsAnonymized clinicopathologic data of OSCC patients from 5 tertiary healthcare institutions in Asia were divided into 3 risk groups according to the NCCN guidelines. Within each risk group, nomograms were built to predict overall survival based on histologic differentiation, histologic margin involvement, depth of invasion (DOI), extranodal extension, PNI, lymphovascular, and bone invasion. Nomograms were internally validated with precision–recall analysis and the Kaplan–Meier survival analysis.ResultsLow-risk patients with positive pathological nodal involvement and/or positive PNI should be considered for adjuvant radiotherapy. Intermediate-risk patients with gross bone invasion may benefit from concurrent chemotherapy. High-risk patients with positive margins, high DOI, and a high composite score of histologic differentiation, PNI, and the American Joint Committee on Cancer (AJCC) 8th edition T staging should be considered for treatment escalation to experimental therapies in clinical trials.ConclusionNomograms built based on prognostic adverse pathological features can be used within each NCCN risk group to fine-tune treatment decisions for OSCC patients.
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Affiliation(s)
- Irene Wen-Hui Tu
- Department of Head and Neck Surgery Singapore General Hospital and National Cancer Centre Singapore and Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Nicholas Brian Shannon
- Department of Head and Neck Surgery Singapore General Hospital and National Cancer Centre Singapore and Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgical Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Deepak Balasubramanian
- Department of Head and Neck Surgical Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Vijay Pillai
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India
| | - Vivek Shetty
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India
| | - Vidyabhushan Rangappa
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India
| | - Naveen Hedne Chandrasekhar
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India
| | - Vikram Kekatpure
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India
| | - Moni Abraham Kuriakose
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India
| | | | - Arun Mitra
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India
| | - Arun Pattatheyil
- Department of Head and Neck Surgical Oncology, Tata Medical Centre, Kolkata, India
| | - Prateek Jain
- Department of Head and Neck Surgical Oncology, Tata Medical Centre, Kolkata, India
| | - Subramania Iyer
- Department of Head and Neck Surgical Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Narayana Subramaniam
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India
- *Correspondence: N. Gopalakrishna Iyer, ; Narayana Subramaniam,
| | - N. Gopalakrishna Iyer
- Department of Head and Neck Surgery Singapore General Hospital and National Cancer Centre Singapore and Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
- *Correspondence: N. Gopalakrishna Iyer, ; Narayana Subramaniam,
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