Abstract
Objective
We sought to improve the prognostic stratification of patients with pN3b oral cavity squamous cell carcinoma (OCSCC) through a combined analysis of FDG-PET parameters and clinicopathological risk factors (RFs).
Methods
Complete data on maximum standardized uptake values derived from FDG-PET of neck metastatic nodes (SUV-nodal-max) and clinicopathological RFs were available for 257 patients with pN3b disease. Participants with pN0/pN1/pN2 (n = 1318/199/213) disease were included for comparison purposes.
Results
Using the 5-year disease-free survival (DFS) rate as the outcome of interest, the optimal cutoff points for SUV-nodal-max and lymph node ratio (LNR) were 15.9 and 0.17, respectively. After stratification with SUV-nodal-max and clinicopathological RFs, the 5-year DFS rates for patients with pN3 disease were as follows: SUV-nodal-max < 15.9 (n = 226) versus SUV-nodal-max ≥ 15.9 (n = 31), 49%/21%, p = 0.000003; LNR < 0.17 (n = 230) versus LNR ≥ 0.17 (n = 27), 49%/17%, p = 0.000117; absence (n = 230) versus presence (n = 27) of neck level IV/V metastases, 49%/15%, p = 0.000004. Multivariable analyses revealed that SUV-nodal-max ≥ 15.9, LNR ≥ 0.17, and the presence of level IV/V metastases were independent prognosticators for 5-year distant metastases (DM), DFS, disease-specific survival (DSS) and overall survival (OS) rates. Based on these variables, we devised a scoring system that identified three distinct prognostic subgroups of low (score 0, n = 190), intermediate (score 1, n = 51), and high (scores 2 − 3, n = 16) risk. The 5-year rates of pN0/pN1/pN2/pN3b of our cohort and the low/intermediate/high risk subgroups of pN3b were as follows: DM, 3%/12%/20%/38% and 31%/52%/89%; DFS, 83%/72%/65%/46% and 54%/26%/0%; DSS, 92%/79%/71%/52% and 59%/36%/8%; OS, 81%/62%/54%/38% and 42%/31%/6%, respectively; all p < 0.001.
Conclusion
A scoring system based on maximum SUV-nodal, LNR, and level IV/V metastases helps improve the prognostic stratification of OCSCC patients with pN3 disease.
Improved prognostic stratification of patients with pN3b oral cavity cancer based on maximum standardized uptake value of metastatic nodes, lymph node ratio, and level of cervical nodal metastases
