Fábio Muradás Girardi, Vivian Petersen Wagner, Cristian David Cardona Machado, Ashley Wysong, Nina A Ran, Emily E Granger, Shlomo A Koyfman, Allison T Vidimos, David R Carr, Kathryn T Shahwan, Kelsey E Hirotsu, John A Carucci, Joi B Carter, Aaron R Mangold, Divya Srivastava, David G Brodland, John A Zitelli, Tyler J Willenbrink, Anokhi Jambusaria-Pahlajani, Rajiv I Nijhawan, Emily S Ruiz, Javier Cañueto
{"title":"HNCSCC当前分期系统的验证：一项跨国队列研究。","authors":"Fábio Muradás Girardi, Vivian Petersen Wagner, Cristian David Cardona Machado, Ashley Wysong, Nina A Ran, Emily E Granger, Shlomo A Koyfman, Allison T Vidimos, David R Carr, Kathryn T Shahwan, Kelsey E Hirotsu, John A Carucci, Joi B Carter, Aaron R Mangold, Divya Srivastava, David G Brodland, John A Zitelli, Tyler J Willenbrink, Anokhi Jambusaria-Pahlajani, Rajiv I Nijhawan, Emily S Ruiz, Javier Cañueto","doi":"10.1002/hed.28259","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>Risk stratification of cutaneous squamous cell carcinoma (CSCC) is central to effective management. Despite advancements in the 8th edition of the American Joint Committee on Cancer (AJCC8) staging system, the distinctiveness of T-stages remains limited.</p><p><strong>Objective: </strong>To evaluate the effectiveness of the Brigham and Women's Hospital (BWH) and the AJCC8 staging systems in predicting poor outcomes in head and neck (HN) CSCC.</p><p><strong>Design: </strong>A retrospective, multinational cohort study of CSCCs diagnosed between January 10, 1991, and December 31, 2023.</p><p><strong>Setting: </strong>Twelve centers across the United States (10), Spain (1), and Brazil (1).</p><p><strong>Participants: </strong>Patients with invasive CSCC who underwent curative-intent surgical treatment. Exclusions included cases of lip CSCC, cases with prior HN cancer with associated regional disease, patients with a history of chemotherapy/radiotherapy for other HN neoplasms, and recurrent primary tumors.</p><p><strong>Exposure: </strong>Tumors were staged according to both the AJCC8 TNM staging system and the BWH tumor classification.</p><p><strong>Main outcomes and measures: </strong>Local recurrence (LR), nodal recurrence (NR), distant recurrence (DR), and disease-specific death (DSD).</p><p><strong>Results: </strong>A total of 9852 excised tumors from 3168 patients were included. The 2 systems had comparable monotonicity and homogeneity. Significant differences could be observed in 5-year cumulative incidence for DSD in both BWH and AJCC8, and also for LR in BWH. Higher T-stages exhibited similar curves regarding NR and DR for both AJCC8 and BWH staging systems. Overall, we observed high specificity and NPV, low sensitivity and PPV, and moderately high c-indices for both the BWH and AJCC8 staging systems in predicting the main outcomes for HNCSCC.</p><p><strong>Conclusion and relevance: </strong>Current AJCC8 and BWH staging systems can accurately predict survival in HNCSCC, although there are still important characteristics to be addressed in future staging systems for better stratification according to the other main outcomes.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Validation of Current Staging Systems in HNCSCC: A Multinational Cohort Study.\",\"authors\":\"Fábio Muradás Girardi, Vivian Petersen Wagner, Cristian David Cardona Machado, Ashley Wysong, Nina A Ran, Emily E Granger, Shlomo A Koyfman, Allison T Vidimos, David R Carr, Kathryn T Shahwan, Kelsey E Hirotsu, John A Carucci, Joi B Carter, Aaron R Mangold, Divya Srivastava, David G Brodland, John A Zitelli, Tyler J Willenbrink, Anokhi Jambusaria-Pahlajani, Rajiv I Nijhawan, Emily S Ruiz, Javier Cañueto\",\"doi\":\"10.1002/hed.28259\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>Risk stratification of cutaneous squamous cell carcinoma (CSCC) is central to effective management. Despite advancements in the 8th edition of the American Joint Committee on Cancer (AJCC8) staging system, the distinctiveness of T-stages remains limited.</p><p><strong>Objective: </strong>To evaluate the effectiveness of the Brigham and Women's Hospital (BWH) and the AJCC8 staging systems in predicting poor outcomes in head and neck (HN) CSCC.</p><p><strong>Design: </strong>A retrospective, multinational cohort study of CSCCs diagnosed between January 10, 1991, and December 31, 2023.</p><p><strong>Setting: </strong>Twelve centers across the United States (10), Spain (1), and Brazil (1).</p><p><strong>Participants: </strong>Patients with invasive CSCC who underwent curative-intent surgical treatment. Exclusions included cases of lip CSCC, cases with prior HN cancer with associated regional disease, patients with a history of chemotherapy/radiotherapy for other HN neoplasms, and recurrent primary tumors.</p><p><strong>Exposure: </strong>Tumors were staged according to both the AJCC8 TNM staging system and the BWH tumor classification.</p><p><strong>Main outcomes and measures: </strong>Local recurrence (LR), nodal recurrence (NR), distant recurrence (DR), and disease-specific death (DSD).</p><p><strong>Results: </strong>A total of 9852 excised tumors from 3168 patients were included. The 2 systems had comparable monotonicity and homogeneity. Significant differences could be observed in 5-year cumulative incidence for DSD in both BWH and AJCC8, and also for LR in BWH. Higher T-stages exhibited similar curves regarding NR and DR for both AJCC8 and BWH staging systems. Overall, we observed high specificity and NPV, low sensitivity and PPV, and moderately high c-indices for both the BWH and AJCC8 staging systems in predicting the main outcomes for HNCSCC.</p><p><strong>Conclusion and relevance: </strong>Current AJCC8 and BWH staging systems can accurately predict survival in HNCSCC, although there are still important characteristics to be addressed in future staging systems for better stratification according to the other main outcomes.</p>\",\"PeriodicalId\":55072,\"journal\":{\"name\":\"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-07-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/hed.28259\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OTORHINOLARYNGOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/hed.28259","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
Validation of Current Staging Systems in HNCSCC: A Multinational Cohort Study.
Importance: Risk stratification of cutaneous squamous cell carcinoma (CSCC) is central to effective management. Despite advancements in the 8th edition of the American Joint Committee on Cancer (AJCC8) staging system, the distinctiveness of T-stages remains limited.
Objective: To evaluate the effectiveness of the Brigham and Women's Hospital (BWH) and the AJCC8 staging systems in predicting poor outcomes in head and neck (HN) CSCC.
Design: A retrospective, multinational cohort study of CSCCs diagnosed between January 10, 1991, and December 31, 2023.
Setting: Twelve centers across the United States (10), Spain (1), and Brazil (1).
Participants: Patients with invasive CSCC who underwent curative-intent surgical treatment. Exclusions included cases of lip CSCC, cases with prior HN cancer with associated regional disease, patients with a history of chemotherapy/radiotherapy for other HN neoplasms, and recurrent primary tumors.
Exposure: Tumors were staged according to both the AJCC8 TNM staging system and the BWH tumor classification.
Main outcomes and measures: Local recurrence (LR), nodal recurrence (NR), distant recurrence (DR), and disease-specific death (DSD).
Results: A total of 9852 excised tumors from 3168 patients were included. The 2 systems had comparable monotonicity and homogeneity. Significant differences could be observed in 5-year cumulative incidence for DSD in both BWH and AJCC8, and also for LR in BWH. Higher T-stages exhibited similar curves regarding NR and DR for both AJCC8 and BWH staging systems. Overall, we observed high specificity and NPV, low sensitivity and PPV, and moderately high c-indices for both the BWH and AJCC8 staging systems in predicting the main outcomes for HNCSCC.
Conclusion and relevance: Current AJCC8 and BWH staging systems can accurately predict survival in HNCSCC, although there are still important characteristics to be addressed in future staging systems for better stratification according to the other main outcomes.
期刊介绍：
Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.
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