Anatomic extent of lymph node metastases as an independent prognosticator in node-positive major salivary gland carcinoma: A study of the US SEER database and a Chinese multicenter cohort |
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| Affiliation: | 1. Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China;2. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China;3. Department of Head and Neck Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;4. Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France;5. Center for Clinical and Research Informatics, Program of Computational Genomics & Medicine, NorthShore University HealthSystem, Department of Public Health Sciences, University of Chicago, Chicago, USA;6. Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, China;7. Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China;8. Department of Head and Neck Surgery, Gansu Province Cancer Hospital, Lanzhou, China;9. Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People''s Hospital, Shanghai, China;10. Department of Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai, China;1. Department of Obstetrics and Gynecology, Spedali Civili of Brescia, Piazzale Spedali Civili 1, Brescia, 25126, Italy;2. Department of Obstetrics and Gynecology, University of Brescia, Italy;3. Department of Pathology, Spedali Civili of Brescia, Italy;4. Department of Radiotherapy, Spedali Civili of Brescia, Italy;1. Peritoneal Surface Malignancy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, via Venezian 1, Milan, MI, CAP 20133, Italy;2. Department of Surgical Oncology, Jehangir Hospital, Sassoon Road, Pune, 411001, Maharashtra, India;3. Department of Gynecologic Oncology, National Cancer Institute of Mexico, Mexico city, CP14080, Mexico;4. Department of Surgical oncology, All India Insitute of medical sciences, Ansari Nagar, New Delhi, Delhi, 110029, India;5. Department of Surgery A, Tel-Aviv Sourasky Medical Center and Sackler Fcaulty of Medicine, Tel Aviv, Israel;1. Scandinavian Surgical Outcomes Research Group (SSORG), Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 416 85, Gothenburg, Sweden;2. Region Västra Götaland, Sahlgrenska University Hospital, Department of Pediatric Oncology, 416 85, Gothenburg, Sweden;3. Region Västra Götaland, Sahlgrenska University Hospital, Department of Surgery, 416 85, Gothenburg, Sweden;4. Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, 405 30, Gothenburg, Sweden;5. Center for Health and Performance, Institute of Food, Nutrition, and Sports Science, University of Gothenburg, 405 30, Gothenburg, Sweden;6. Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine, Geriatrics, and Emergency Medicine, 416 85, Gothenburg, Sweden;7. Health Metrics Unit, The Sahlgrenska Academy, University of Gothenburg, Sweden;1. Republican Centre for Thyroid Tumours, Department of Pathology, Nezavisimosty Av., 64, 220013, Minsk, Belarus;2. Republican Centre for Thyroid Tumours, Head and Neck Surgery Department, Nezavisimosty Av., 64, 220013, Minsk, Belarus;3. United Institute of Informatics Problems, National Academy of Sciences of Belarus, Surganova St. 6, 220012, Minsk, Belarus;4. New York Ear, Nose and Throat Institute, 1810 Voorhies Ave, Brooklyn, NY, 11235, United States;5. Department of Surgery, University of Hong Kong, Hong Kong;6. School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia;1. Departments of Surgery, University Medical Center Utrecht Cancer Center, St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands;2. Department of Radiology, Cancer Center Amsterdam, Amsterdam UMC, VU University, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands;3. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, the Netherlands;4. Department of Radiology, University Medical Center Utrecht Cancer Center, University of Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands;5. Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands;6. Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands |
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| Abstract: | BackgroundWe aimed to explore whether the anatomic extent of lymph node metastases (AE-LNM) could independently predict prognosis of node-positive major salivary gland carcinoma (MaSGC).MethodsA total of 376 pathologically node-positive MaSGC patients were identified from the Surveillance, Epidemiology and End Results database and constituted the training cohort. Using the X-Tile program, these patients were divided into three groups based on AE-LNM degrees. Discrimination of overall survival (OS) and disease-specific survival (DSS) was evaluated and compared with the 8th American Joint Committee on Cancer (AJCC) pN classification. The results were externally validated by 220 patients in a Chinese multicenter cohort (Validation cohort).ResultsUsing the training cohort, AE-LNM was divided into Extent 1 (spread to parotid LNs or level I), Extent 2 (spread to level II-IV) and Extent 3 (spread to level V or bilateral LNs or rare LNs). Regarding both OS and DSS, the AE-LNM model revealed clear separation of survival curves, while the pN classification failed to discriminate the prognosis of pN1 and pN2 patients. When we incorporated both the AE-LNM model and AJCC pN classification into the same multivariate Cox analyses, AE-LNM was still an independent prognostic factor, while the AJCC pN classification lost its significance. These results were externally validated by the validation cohort.ConclusionAE-LNM is an independent nodal prognosticator for node-positive MaSGC and may have improved discriminative ability over the current AJCC pN classification. Integration of anatomic extent of LNM into the current AJCC N classification could be considered. |
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| Keywords: | Major salivary gland carcinoma Anatomic extent Lymph node metastasis SEER Multicenter |
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