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.
Association Between Lymph Node Ratio and Recurrence and Survival Outcomes in Patients With Oral Cavity Cancer
